Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America.
Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, Ann Arbor, MI, United States of America.
J Crit Care. 2019 Jun;51:192-197. doi: 10.1016/j.jcrc.2019.02.028. Epub 2019 Mar 1.
Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination.
We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders.
Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome.
Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.
协调能力差可能会妨碍实施苏醒、呼吸协调、谵妄监测/管理和早期运动/活动（ABCDE）方案包。建立一个共享心智模型（SMM），使所有团队成员都在同一页上，可能有助于协调。
我们在 2016 年 MHA 基石中心 ICU 研讨会上进行了一项调查。我们使用经过验证的调查中的五个项目来衡量 SMM 的不同组成部分，每个项目都在 5 点李克特量表上（非常同意-非常不同意）。我们使用一个 4 点李克特量表（ABCDE 是常规的-没有采取任何步骤来实施 ABCDE）来衡量自我报告的常规 ABCDE 实施情况。我们使用逻辑回归检查了 SMM 与常规 ABCDE 实施之间的关系，同时调整了混杂因素。
在 206 份（75%）答复中，有 157 份（84%）报告使用了 ABCDE 方案包，有 80 份（157 份中的 51%）报告常规使用。当临床医生认为难以预测团队成员的行为时，报告常规 ABCDE 实施的几率显著降低[0.26（0.10-0.66）]。其他与了解团队成员技能、获取信息、团队适应性和团队帮助行为相关的 SMM 组成部分与结果没有显著关联。
提高对团队成员行为的认识可能是改善像 ABCDE 这样的复杂护理方案包实施的一种机制。
