L. Gotlib Conn1, B. Haas3, B. H. Cuthbertson1,4, A. Amaral1,4, N. Coburn2,5, S. Goddard4, L. Nusdorfer4, A. B. Nathens1,2 1Sunnybrook Research Institute,Evaluative Clinical Sciences/Trauma, Emergency And Critical Care Research Program,Toronto, ONTARIO, Canada 2Sunnybrook Health Sciences Centre,Surgery,Toronto, ONTARIO, Canada 3University of Toronto,Critical Care Medicine,Toronto, Ontario, Canada 4Sunnybrook Health Sciences Centre,Critical Care Medicine,Toronto, ONTARIO, Canada 5Sunnybrook Research Institute,Odette Cancer Research Program,Toronto, ONTARIO, Canada
Introduction:
Ineffective communication between providers in the ICU is associated with a higher rate of errors and harmful effects on provider and patient family relations. Improving communication across providers may significantly enhance patient safety and improve provider-family interactions. To identify opportunities for improvement, we explored communication behaviors and practices between surgical and critical care teams treating trauma/surgical patients in a closed ICU.
Methods:
We conducted a qualitative ethnographic study of communication practices and behaviors of trauma, general surgery, neurosurgery and critical care teams in 3 academic ICUs, totaling 50 hours of observation. Additional data were derived from focused interviews (n=46) with surgeons, intensivists, surgical residents, intensive care fellows and ICU nurses. Data were collected and analyzed iteratively to the point of theoretical saturation.
Results:
Observed communication between surgical and ICU teams focused on negotiating contested boundaries of expertise, patient ownership, and decisional authority. Participants described features of effective communication involving successful negotiation of these boundaries leading to collaborative patient care. Ineffective communication involved poor boundary negotiation leading to provider frustration and inter-team conflict (figure). Several discrete communication behaviors and practices between surgical and critical care teams were identified; specific behaviors and practices were closely associated with either enhanced or suboptimal communication across teams. In addition, multiple structures and processes of care currently in place were identified as barriers to effective communication between teams, creating delays and gaps in information transfer impacting the quality of patient care.
Conclusion:
Opportunities exist to improve collaborative communication between surgery and critical care teams. In addition to targeting specific structures and processes of care, interventions aimed to elucidate competing cultures of care, strengthen provider relationships, and mitigate negative behaviors should be evaluated to address interdisciplinary collaboration with a view to enhancing surgical patient safety in the closed ICU.
