Search

Background Safe, reliable, high-quality critical care delivery depends upon interprofessional teamwork. Objective To describe perceptions of intensive care unit (ICU) teamwork and healthy work environments and evaluate whether perceptions vary by profession. Methods In August 2015, Assessment of Interprofessional Team Collaboration Scale (AITCS) and the American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) surveys were distributed to all interprofessional members at the 68 ICUs participating in the ICU Liberation Collaborative. Overall scores range from 1 (needs improvement) to 5 (excellent). Results Most of the 3586 surveys completed were from registered nurses (51.2%), followed by respiratory therapists (17.8%), attending physicians (10.5%), rehabilitation therapists (8.3%), pharmacists (4.9%), nursing assistants (3.1%), and physician trainees (4.1%). Overall, respondents rated teamwork and work environment health favorably (mean [SD] scores: AITCS, 3.92 [0.64]; HWEAT, 3.45 [0.79]). The highest-rated AITCS domain was “partnership/shared decision-making” (mean [SD], 4.00 [0.63); lowest, “coordination” (3.67 [0.80]). The highest-scoring HWEAT standard was “effective decision-making” (mean [SD], 3.60 [0.79]); lowest, “meaningful recognition” (3.30 [0.92]). Compared with attending physicians (mean [SD] scores: AITCS, 3.99 [0.54]; HWEAT, 3.48 [0.70]), AITCS scores were lower for registered nurses (3.91 [0.62]), respiratory therapists (3.86 [0.76]), rehabilitation therapists (3.84 [0.65]), and pharmacists (3.83 [0.55]), and HWEAT scores were lower for respiratory therapists (3.38 [0.86]) (all P ≤ .05). Conclusions Teamwork and work environment health were rated by ICU team members as good but not excellent. Care coordination and meaningful recognition can be improved.

Introduction: Mechanical thrombectomy (MT) has a time-dependent effect on clinical outcomes in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO). Most AIS patients who need MT evaluation present to a spoke Emergency Room (ER) and require transfer to a comprehensive stroke center (CSC) hub. Delayed or incomplete interdisciplinary team communication are potential barriers to timely MT. The purpose of this quality improvement (QI) project was to evaluate team members’ fidelity and acceptability to a new handoff protocol and effect on treatment times. Methods: Our academic CSC has a hub-spoke telestroke model that includes 27 spoke ERs in Ohio. An LVO handoff protocol was designed to ensure a structured process that required the telestroke physician to a) communicate to the receiving in-house stroke team and endovascular team; b) hand-off standardized data from transferring hospital including last known normal, National Institutes of Health Stroke Scale, and neuroimaging findings, and c) communicate a pre-arrival plan. Fidelity was measured by a standardized checklist and Acceptability was measured by Acceptability of Intervention Measure (AIM) questionnaire. Door-to-Groin (DTG) times 4 months pre- and 5 months post- implementation were reviewed. Results: Among 83 AIS patients (28 pre- and 55 post-implementation) transferred from a telestroke ER for suspected LVO, the mean age was 70.4 (± 13.7) and 32 (39%) were female. Overall fidelity was 81% with the lowest scores noted on weekends. Acceptability among team members was 96%. Overall DTG mean time was 64.0 minutes (+/- SD 51) for the entire period. The mean DTG improved from pre-protocol to post-protocol period by 29.2 minutes (83.4 vs. 54.2 min, p = 0.0136). Conclusions: Standardized pre-arrival interdisciplinary team communication for AIS LVO patients transferred to CSC in a telestroke hub-stroke model was feasible and associated with improvement in DTG times. Further studied needed for sustainability and ongoing improvement.

Background The ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor. Objective To assess the effect of quality improvement collaborative participation on ABCDEF bundle performance. Methods This interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation. Results Complete bundle performance rates were very low at baseline ( Conclusions Quality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.

The aging of the baby boomers comes at a time of a growing nursing workforce shortage: registered nurses, nurse aides, and nursing faculty. Older adults have multiple physical, social, and psychological conditions, making the assessment, planning, and delivery of health care more complex than that of younger adults. Not surprisingly, this age group also utilizes the majority of health services in the country. Thus, most nurses will provide care to older adults in a variety of settings. However, the majority of nurses have little to no background in geriatric nursing. These multiple forces: aging population with complex needs, nursing work force shortage, and lack of geriatric knowledge, along with fewer resources, will have a grave impact on health care in this country in the near future. This article reviews issues related to an aging population, the projected nursing workforce shortage, and the lack of geriatric nursing education; it concludes with suggestions for future health care delivery to the geriatric population in the US