Interprofessional team interactions about complex care in the ICU: pilot development of an observationalrating tool.

Costa DK1, Dammeyer J2, White M3, Galinato J4, Hyzy R2,5, Manojlovich M3, Sales A6,7.

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Abstract

BACKGROUND:

The awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle is a multicomponent complexintervention that improves outcomes for critically ill adults yet is inconsistently implemented. Effective interprofessional team function (how theteam interacts) is key to ABCDE delivery but little is known about how to measure team interactions. The purpose of our study was to examine the reliability of an observational rating tool to assess team interactions about ABCDE in one ICU.

RESULTS:

We pilot tested and evaluated reliability of an observational rating tool to assess team interactions about ABCDE. Two independent raters used this tool in one medical ICU over 4 weeks during morning rounds. We examined which ABCDE components were addressed, whichteam members initiated interactions, and which participated in interactions about ABCDE. We evaluated inter-rater reliability using Cohen's kappa statistic and data from interprofessional team interactions for 23 patients. We demonstrated moderate to substantial reliability for whether breathing, coordination, delirium or early mobility were addressed (k = 0.48-0.78) and slight to fair reliability for which team members initiatedinteractions about ABCDE (0.18-0.40). Reliability was low for whether Awakening was addressed (k = -0.07) and for which team members initiatedinteractions about awakening (k = 0.05).

CONCLUSIONS:

Our study provides pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE. Future work should further test and modify this tool to gain an understanding of how to use team interactions to improve ABCDE delivery.