The EIC-ICU (Enhancing Interprofessional Collaboration in the Intensive Care Unit) toolkit
Published Date: 20th May 2020
Publication Authors: Cochrane A
Introduction
Effective interprofessional collaboration (IPC) in intensive care units (ICUs) has been associated with better patient outcomes such as reduced mortality rates and length of ICU stay. The level of IPC also predicts the degree to which team members report understanding their patient care goals and how productive they are at achieving these goals. This way of working increases team function and morale and leads to a reduced staff turnover.
Objectives
Reeves et al. (2016) published the EIC-ICU toolkit to aid IPC improvement efforts in intensive care. This details effective methods of evaluating barriers to IPC and selecting appropriate interventions. Using this toolkit, we undertook a quality improvement project to increase the level of IPC in a single-centre intensive care unit in the North West of England. We structured the project using a ‘Plan, Do, Study, Act’ (PDSA) cycle framework.
Methods
Qualitative data was collected through ethnographic observation and one to one interviews. Field notes on interprofessional interactions were collected over approximately 20 hours of observation across varied shift patterns and locations on the unit. Members of the ICU team were invited for semi-structured interviews. Questions explored their perception of different professions’ roles and responsibilities, their relationships with different healthcare professionals and their perceived barriers to effective IPC. Quantitative data was also collected using a 5-point scale questionnaire.
These results were used to facilitate an interprofessional workshop, with the primary aim of raising awareness of the importance of IPC in intensive care. Attendees included ICU physicians, nurses, pharmacists, physiotherapists, dieticians, occupational therapists, speech and language therapists and healthcare assistants. The observational and interview data was presented at this workshop and used to construct a perception of roles matrix to explore the interactions between different professional groups. The workshop facilitated various group activities, both educational and team building, which encouraged participants to elaborate on our observational findings using the PROC (processual, relational, organizational, and contextual) framework. In exploring these themes participants were invited to offer suggestions for how to improve IPC on the unit.
Results
Our data indicated that good relationships existed between physicians and nurses and that conflict seldom occurred. Physicians interacted less frequently with the other members of the intensive care team such as physiotherapists and dieticians. The major barriers to these interactions were time constraints and workload. Many unit staff members cover multiple wards and therefore do not have the time available to attend daily ward rounds or multi-disciplinary meetings. Further barriers included different priorities in care across professional groups, the lack of consistency in leadership, and frequent staff rotations without introductions.
The IPC workshop received positive feedback from participants. The outcomes of the workshop included a number of suggestions for improvement, which we grouped into four themes (Team-building, simulation/educational, MDT meeting and handover improvements). Post workshop staff members undertook a prioritisation exercise to identify which interventions to implement. These will then be assessed as part of further PDSA cycles.
Conclusion
The EIC-ICU toolkit provides a useful structure for exploring and enhancing IPC in an Intensive Care Unit.
Partington, J; Cochrane, A. (2020). The EIC-ICU (Enhancing Interprofessional Collaboration in the Intensive Care Unit) toolkit: One institution's experience with a new quality improvement initiative. Journal of the Intensive Care Society. 21 (2), 108-109