Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

• Published in: Journal of critical care Vol. 51; pp. 192 - 197
• Main Authors: Boltey, Emily M., Iwashyna, Theodore J., Hyzy, Robert C., Watson, Sam R., Ross, Corine, Costa, Deena Kelly
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019; Elsevier Limited
• Subjects: Adult; Behavior; Best practice; Critical care; Critical Care - methods; Critical Care - organization & administration; Cross-Sectional Studies; Delirium - prevention & control; Early Ambulation - methods; Female; Hospitals; Humans; Implementation science; Intensive Care Units; Logistic Models; Male; Mechanical ventilation; Medical research; Middle Aged; Patient assessment; Patient Care Team - organization & administration; Patients; Respiration, Artificial - methods; Shared mental model; Teams; Teamwork; Michigan; Teamwork; Shared mental model; Mechanical ventilation; Implementation science
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.02.028

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. •This paper examines perception of shared mental models (SMM) and ABCDE delivery.•One SMM item, ability to predict team behavior, is associated with perceived routine delivery.•Awareness of team members' behaviors may play a role in complex care delivery.