Establishing and justifying specialized teams in intensive care units for nutrition, ventilator management, and palliative care.
The team concept should be better appreciated and used as a tool for managing or solving problems in the ICU. If teams are designed improperly or employed inappropriately, however, they can easily fragment care and interfere with efficiency. Formally rounding with three or four teams a day is bound to lead to chaos and is impractical, but the team can be used to generate multidisciplinary protocols that reduce the need for formal face-to-face interaction. The team also can be convened when problems arise. In all three areas discussed in this article, specific teams were carefully formed in response to perceived problems in patient care. A great deal of attention was paid to determining the problems, and approaches were designed to resolve them in the most expedient manner possible. The results reported from all three types of teams are impressive. The team approach also has an unmeasured beneficial effect on staff morale. Although much of this discussion is intuitive, it must be emphasized that the types of interactions described in this article and the resulting positive outcomes happened not by accident, but by careful and conscious design. More research is needed in critical care areas to best define how to optimize the use of personnel. After all, volumes of data are generated on drugs, technologies, and other medical issues that often show little, if any, impact on outcome. The human component of the ICU is by far the most valuable and expensive commodity; we can ill afford to misapply it.
Cohen
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Surgical Intensive Care Unit, Albany Medical Center Hospital, NY.
D002985:Clinical Protocols; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D009747:Nutritional Physiological Phenomena; D010166:Palliative Care; D010348:Patient Care Team / Q000458:organization & administration*; D012121:Respiration, Artificial; D014481:United States