Q&A: Importance of collective knowledge among ICU staff

Key takeaways:

• Working in the ICU requires collaboration among the staff to ensure patient-centered care.
• Cultural factors and environmental issues may negatively impact teamwork in the ICU.

Patients in critical condition in the ICU are often treated by several different health care professionals who must make sure they are working together and communicating to deliver care that aligns with each specific patient’s goals.

Failure in sharing this information could have a significant impact on not only the patient but also the patient’s family and the rest of the ICU team.

To learn more about teamwork in the ICU and factors that contribute to failed communication, Jacqueline M. Kruser, MD, MS, assistant professor of medicine in the division of allergy, pulmonary and critical care medicine at the University of Wisconsin-Madison, and colleagues conducted a study that looked at how ICU teams might employ transactive memory systems, a theory that involves collective cognition.

Healio spoke with Kruser to learn more about the importance of ICU team collaboration, what transactive memory systems are and how they are apparent within ICU teams, and what the results of their study showed.

Healio: Why are there difficulties in aligning care with patient goals within the ICU?

Kruser: When patients are critically ill and come to the ICU, there is often a huge amount of uncertainty. Sometimes, there is uncertainty about the underlying cause or causes for the critical illness and it takes time for test results to come back. Other times, we may know the cause but are still uncertain about whether and how much the patient will recover, even with the best treatments we have. On top of the uncertainty, the decisions that need to be made for patients who are critically ill are often very urgent. Because of the uncertainty and urgency, it can be very challenging to align the care with patients’ goals.

Healio: Could you explain what interprofessional collaboration entails? Why is this a good practice to adopt in the ICU?

Kruser: In many ICUs in the United States, we are fortunate to have teams of professionals to care for critically ill patients. Each of the professions on the team has a different and highly specialized role, but we need all of the roles working together in order to take the best care of the patient. Without collaboration, the plan for a patient in the ICU becomes fragmented, inefficient and ineffective.

Healio: When studying teamwork within the ICU, you used the transactive memory systems theory. What is this theory and why did you choose it?

Kruser: Transactive memory systems theory came from the field of psychology as a way to help explain how high-functioning groups of people develop something called a “group mind,” or a collective way of thinking, that extends the cognitive capacity of any one individual. One of the first descriptions of this theory actually came from long-term marriages, where partners tend to rely on each other for keeping track of different things — like birthdays and addresses vs. the stock of stamps to mail a birthday card. When we started to analyze our qualitative data, we saw early evidence of a knowledge-sharing process within ICU teams that resembled transactive memory. Because this could be a new way to help ICU teams improve, we undertook this study to learn more about transactive memory and how it plays out in the ICU.

Healio: This qualitative study involved interprofessional ICU and palliative care team members, surrogates and survivors from the ICU. Why was it important to capture these voices?

Kruser: When a patient is critically ill in the ICU, they become positioned at the center of a large, complex social network that includes people from their own life and the large interprofessional team that is caring for them. This team also includes specialists outside of the ICU, such as palliative care specialists. Because we were aiming to paint a rich picture of collaboration within the ICU, we wanted to make sure the voices of as many of the people affected by critical illness were included.

Healio: What are the key findings from your study?

Kruser: We found that ICU teams do, in fact, use transactive memory systems to build a shared, collective understanding of how best to take care of a critically ill patient, including aligning that care with patient goals. However, these memory systems are sometimes disrupted or unsuccessful because of the culture and the environment of the ICU. What this means is that addressing cultural factors (like hierarchy within the team) or environmental issues (like inadequate electronic health records) could improve collaboration within ICU teams and, ultimately, patient care.

Healio: Do you have any plans for future studies on this topic? What ideas/concepts need to be further researched?

Kruser: We are planning a new observational study to identify and learn more about which strategies best promote and sustain collaboration in the ICU, especially over the multiple days that a patient is cared for in this setting.

Reference:

• Kruser JM, et al. Ann Am Thorac Soc. 2023; doi:10.1513/AnnalsATS.202209-820OC.

For more information:

Jacqueline M. Kruser, MD, MS, can be reached at jkruser@wisc.edu.