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Interprofessional Care and Teamwork in the ICU

Donovan, Anne L. MD1; Aldrich, J. Matthew MD1; Gross, A. Kendall PharmD2,3; Barchas, Denise M. RN, MSN4; Thornton, Kevin C. MD1; Schell-Chaple, Hildy M. RN, PhD4,5; Gropper, Michael A. MD, PhD1; Lipshutz, Angela K. M. MD, MPH1; on behalf of the University of California, San Francisco Critical Care Innovations Group

doi: 10.1097/CCM.0000000000003067
Concise Definitive Review
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Objectives: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success.

Data Sources: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles.

Study Selection: Original articles, review articles, and systematic reviews were considered.

Data Extraction: Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles.

Data Synthesis: Interprofessional care” refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care.

Conclusions: A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.

1Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.

2Pharmaceutical Services, School of Pharmacy, University of California, San Francisco, CA.

3Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA.

4Department of Nursing, University of California, San Francisco, CA.

5Patient Safety and Regulatory Affairs, Department of Patient Safety, University of California, San Francisco, CA.

The members of the University of California, San Francisco Critical Care Innovations Group are listed in Appendix 1.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by a grant from the Gordon and Betty Moore Foundation. All authors received funding from grant 4358 from the Gordon and Betty Moore Foundation.

Drs. Donovan, Thornton, Schell-Chaple, and Lipshutz’s institutions received funding from the Gordon and Betty Moore Foundation. Dr. Aldrich received funding from the Society of Critical Care Medicine’s ICU Liberation Collaborative and Committee, from previous support from the Gordon and Betty Moore Foundation for project work related to harm reduction in the ICU (although this grant support predated the writing of this review), and from National Institutes of Health R01 HL128679 (coinvestigator). Drs. Gross and Barchas received funding from the Gordon and Betty Moore Foundation. Dr. Thornton received funding from serving as an expert witness in a legal case that was unrelated to the topic of this article, and he provided expert opinion on the standard of care. He was paid by the law firm representing a physician. Dr. Lipshutz received support for article research from the Gordon and Betty Moore Foundation. Dr. Gropper has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: anne.donovan@ucsf.edu

Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.