Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, and.
Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin.
Ann Am Thorac Soc. 2023 Apr;20(4):548-555. doi: 10.1513/AnnalsATS.202209-820OC.
Although aligning care with patient goals is fundamental to critical care, this process is often delayed and leads to conflict among patients, families, and intensive care unit (ICU) teams. Interprofessional collaboration within ICU teams is an opportunity to improve goal-aligned care, yet this collaboration is poorly understood. A better understanding of how ICU team members work together to provide goal-aligned care may identify new strategies for improvement. Transactive memory systems is a theory of group mind that explains how high-performing teams use a shared memory and collective cognition. We applied this theory to characterize the process of interprofessional collaboration within ICU teams and its relationship with goal-aligned care. We conducted a secondary analysis of focus group ( = 10) and semistructured interview ( = 8) transcripts, gathered during a parent study at two academic medical centers on the process of ICU care delivery in acute respiratory failure. Participants ( = 70) included interprofessional ICU and palliative care team members, surrogates, and patient survivors. We used directed content analysis, applying transactive memory systems theory and its major components (specialization, coordination, credibility) to examine ICU team collaboration. Participants described each ICU profession as having a specialized role in aligning care with patient goals. Different professions have different opportunities to gather knowledge about patient goals and priorities, which results in dispersion of this knowledge among different team members. To share and use this dispersed knowledge, ICU teams rely on an informal coordination process and "side conversations." This process is a workaround for formal channels (e.g., health records, interprofessional rounds) that do not adequately convey knowledge about patient goals. This informal process does not occur if team members are discouraged from asserting their knowledge because of hierarchy or lack of psychological safety. Conversely, coordination succeeds when team members recognize each other as credible sources of valued knowledge. We found that ICU team members work together to align care with patient goals and priorities, using transactive memory systems. The successful function of these systems can be disrupted or promoted by ICU organizational and cultural factors, which are potential targets for efforts to increase goal-aligned care.
虽然将护理与患者目标保持一致是重症监护的基础，但这一过程往往会被延迟，导致患者、家属和重症监护病房（ICU）团队之间产生冲突。ICU 团队内的跨专业协作是改善目标一致护理的机会，但这种协作却知之甚少。更好地了解 ICU 团队成员如何共同提供目标一致的护理，可能会确定新的改进策略。
群体思维的交互记忆系统理论解释了高绩效团队如何使用共享记忆和集体认知。我们将这一理论应用于描述 ICU 团队内的跨专业协作过程及其与目标一致护理的关系。
我们对两个学术医疗中心的一项关于急性呼吸衰竭 ICU 护理提供过程的父母研究中的焦点小组（ = 10）和半结构化访谈（ = 8）记录进行了二次分析。参与者（ = 70）包括跨专业 ICU 和姑息治疗团队成员、代理人和患者幸存者。我们使用有针对性的内容分析，应用交互记忆系统理论及其主要组成部分（专业化、协调、可信度）来检查 ICU 团队协作。
参与者描述了每个 ICU 专业在将护理与患者目标保持一致方面的专业作用。不同的专业有不同的机会收集有关患者目标和优先事项的知识，这导致这些知识在不同的团队成员之间分散。为了共享和使用这些分散的知识，ICU 团队依赖于非正式的协调过程和“旁侧对话”。如果团队成员因等级制度或缺乏心理安全感而不愿坚持自己的知识，那么这个过程就是正式渠道（如健康记录、跨专业轮班）无法充分传达患者目标知识的权宜之计。如果团队成员认识到彼此是有价值知识的可信来源，那么协调就会成功。
我们发现，ICU 团队成员使用交互记忆系统共同努力将护理与患者目标和优先事项保持一致。这些系统的成功运作可能会因 ICU 组织和文化因素而受到干扰或促进，这些因素是增加目标一致护理的努力的潜在目标。
