DOI: 10.1097/01.CCM.0000055367.08442.A4

,  

,  

PMID: 12627029

Issn Print: 0090-3493

Publication Date: 2003/03/01


Print

Teamwork and collaboration in critical care: Lessons from the cockpit *

Stephen D. Surgenor; George T. Blike; Howard L. Corwin

    loading  Checking for direct PDF access through Ovid

Excerpt

Teamwork and collaboration is key to success in the intensive care unit (ICU). The “belief in the multidisciplinary, multiprofessional critical care team” is a core value of the Society of Critical Care Medicine (http://www.sccm.org/about/ mission.html). In addition to being a laudable value, effective teamwork and collaboration is associated with lower risk-adjusted length of stay, lower nurse turnover, higher quality of care, and better ability to meet the needs of families (1). Good collaboration is also associated with better outcome after transfer, as measured by readmission or death after discharge from the ICU (2).
In this issue of Critical Care Medicine, Dr. Thomas and colleagues (3) present the results of a survey of critical care physicians and nurses of their perception of the teamwork and collaboration in their units. This survey was completed in a mix of open and closed, community and tertiary medical ICUs. The main finding is that the group of nurses in these units reported high levels of collaboration or teamwork with their nursing peers but much lower levels of collaboration with physicians. Specifically, the nurses reported difficulty speaking up, disagreements not resolved, nurse input not well received, and the desire for more input into decision-making. In contrast, the group of physicians reported high levels of collaboration with both nurses and physicians.
Why is there such a discrepancy in the perception of collaboration between physicians and nurses, and more importantly, does this discrepancy reflect actual clinical practice or just perception? Before entertaining these questions, methodologic issues that could influence this study’s results should be reviewed.
Potential differences between nurses’ and physicians’ cultures include status, authority, gender, training, and responsibilities. Dr. Thomas and colleagues (3) appropriately note that the differences regarding the perceptions of teamwork between nurses and physicians could be explained by gender. This study is confounded by the fact that the physician group was predominantly male and the nurse group was mostly female. Male nurses and female physicians were too few in this study to allow for analysis. The mixture of unit type (open vs. closed, teaching vs. community) is another confounding factor. It is not clear whether either unit type or practice pattern within the individual units impacted on the findings. In addition, the survey is vulnerable to nonresponse bias, as the response rate was only 40% for the physicians but 71% for the nurses. Physician survey studies frequently encounter problems achieving acceptable response rates. The average response rate in physician surveys is lower than surveys administered to nonphysician groups. Comparisons of respondents with nonrespondents based on information from the sampling frame can offer the opportunity to assess differences in the demographic and other characteristics of the two groups but cannot assist in determining whether the survey responses themselves are representative. Moreover, for most of the information collected through physician surveys, there is no alternative source, making it difficult to ascertain the extent of nonresponse bias present in a study. However, studies comparing the characteristics of physician respondents with nonrespondents and early to late respondents have rarely found large differences between these groups. The physicians found to be less likely to respond include those who are older and busier, with less potential interest in the survey topic, and graduates of foreign medical schools (4).
Despite these limitations, to those working in critical care settings, the results reported here by Dr. Thomas and colleagues (3) are not surprising.
    loading  Loading Related Articles