Advertisement

How care decisions are made among interdisciplinary providers caring for critically injured patients: A qualitative study

Published:December 13, 2019DOI:https://doi.org/10.1016/j.surg.2019.11.009

      Abstract

      Background

      Injury is the leading cause of death in people under 45 years of age in the United States; however, how care decisions occur in critical injury is poorly understood. This exploratory study sought to generate hypotheses about how care decisions are made among interdisciplinary providers caring for patients who have been critically injured.

      Methods

      This was a qualitative study conducted at two intensive care units in a level 1 trauma center in an urban, teaching, safety-net hospital. Semistructured interviews consisted of case scenarios with competing clinical priorities presented to 25 interdisciplinary providers, elucidating how decisions are approached. Responses were recorded, transcribed, and coded. Thematic analysis was conducted to discover central themes. Category formulation and sorting was done for data reduction and thematic structuring of the data. The range and central tendency of these themes are reported.

      Results

      The central theme for how care decisions are made among interdisciplinary providers was through the distribution of shared responsibility. The distribution of shared responsibility depended on interdisciplinary communication to navigate the two subthemes of time and roles. Time had to be navigated carefully, because it was both an opportunity for data acquisition and consensus building but also a pressure to decisively progress care. Roles were distinct but interchangeable and consisted of experts, actualizers, and questioners.

      Conclusion

      Care decisions are made in the context of shared responsibility among interdisciplinary providers. Interdisciplinary communication is a means of establishing roles and navigating time to distribute shared responsibility among interdisciplinary providers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        National Center for Health Statistics Z-force data files Web site.
        https://www.cdc.gov/growthcharts/zscore.htm
        Date accessed: February 4, 2019
        • Davis J.W.
        • Hoyt D.B.
        • McArdle M.S.
        • Mackersie R.C.
        • Shackford S.R.
        • Eastman A.B.
        The significance of critical care errors in causing preventable death in trauma patients in a trauma system.
        J Trauma. 1991; 31 (discussion 818–819): 813-818
        • Balas M.C.
        • Burke W.J.
        • Gannon D.
        • et al.
        Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines.
        Crit Care Med. 2013; 41: S116-S127
        • Fackler J.C.
        • Watts C.
        • Grome A.
        • Miller T.
        • Crandall B.
        • Pronovost P.
        Critical care physician cognitive task analysis: an exploratory study.
        Crit Care. 2009; 13: R33
        • Edwards B.D.
        • Day E.A.
        • Arthur W.
        • Bell S.T.
        Relationships among team ability composition, team mental models, and team performance.
        J Appl Psychol. 2006; 91: 727-736
        • Mathieu J.E.
        • Heffner T.S.
        • Goodwin G.F.
        • Salas E.
        • Cannon-Bowers J.A.
        The influence of shared mental models on team process and performance.
        J Appl Psychol. 2000; 85: 273-283
        • Ferguson E.J.
        • Brown M.
        Concurrent case review and retrospective review using the matrix method are complementary methods for tracking and improving timeliness of care in a level I trauma center.
        Am Surg. 2016; 82: 319-324
        • Girard E.
        • Jegousso Q.
        • Boussat B.
        • et al.
        Preventable deaths in a French regional trauma system: a six-year analysis of severe trauma mortality.
        J Visc Surg. 2019; 156: 10-16
        • Sharwood L.N.
        • Stanford R.
        • Middleton J.W.
        • et al.
        Improving care standards for patients with spinal trauma combining a modified e-Delphi process and stakeholder interviews: a study protocol.
        BMJ Open. 2017; 7e012377
        • Weldon S.M.
        • Korkiakangas T.
        • Bezemer J.
        • Kneebone R.
        Communication in the operating theatre.
        Br J Surg. 2013; 100: 1677-1688
        • Leonard M.
        • Graham S.
        • Bonacum D.
        The human factor: the critical importance of effective teamwork and communication in providing safe care.
        Qual Saf Health Care. 2004; 13: i85-i90
        • Southwick F.
        Who was caring for Mary?.
        Ann Intern Med. 1993; 118: 146-148
        • Southwick F.S.
        • Spear S.J.
        Commentary: “Who was caring for Mary?” revisited: a call for all academic physicians caring for patients to focus on systems and quality improvement.
        Acad Med. 2009; 84: 1648-1650
        • Rangachari P.
        • Rissing P.
        • Wagner P.
        • et al.
        A baseline study of communication networks related to evidence-based infection prevention practices in an intensive care unit.
        Qual Manag Health Care. 2010; 19: 330-348
        • Sexton J.B.
        • Makary M.A.
        • Tersigni A.R.
        • et al.
        Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.
        Anesthesiology. 2006; 105: 877-884
        • Shoham D.A.
        • Harris J.K.
        • Mundt M.
        • McGaghie W.
        A network model of communication in an interprofessional team of healthcare professionals: a cross-sectional study of a burn unit.
        J Interprof Care. 2016; 30: 661-667
        • Alvarez G.
        • Coiera E.
        Interdisciplinary communication: an uncharted source of medical error?.
        J Crit Care. 2006; 21 (discussion 242): 236-242
        • Sexton J.B.
        • Thomas E.J.
        • Helmreich R.L.
        Error, stress, and teamwork in medicine and aviation: cross sectional surveys.
        BMJ. 2000; 320: 745-749
        • Williams M.
        • Hevelone N.
        • Alban R.F.
        • et al.
        Measuring communication in the surgical ICU: better communication equals better care.
        J Am Coll Surg. 2010; 210: 17-22