Coordination and continuity of intensive care unit patient care.
OBJECTIVE
Using Klein's model of team coordination, we explored the null hypothesis that intensive care unit (ICU) care coordination unfolds as a linear sequence. Our intent was to generate hypotheses for further research and to provide interim recommendations for improving care coordination. We also explored factors contributing to care coordination (e.g., role responsibilities, support tools).


BACKGROUND
Although the body of clinical communications research is considerable, few studies address broader team processes in real-world environments; hence, these processes are not well understood.


METHODS
All bedside communications for 5 ICU patients were recorded for 5 days per patient and were coded using Klein's model. Markov analysis was used to describe the care coordination process. Multivariate contingency table analysis and standardized parameter estimates described important contributing factors, and support tools were described using descriptive statistics.


RESULTS
First-, second-, and third-order Markov analyses show that care coordination does not unfold as a linear sequence; however, Markov diagrams suggest some process structure. Standardized parameter estimates of factors contributing to care coordination were calculated from a statistically significant three-way model (chi2[df= 18] = 36.95, p < .005). Role-based differences depend on context, with important differences in contributions to care coordination occurring within rounds. Tools supported only 48% of conversations.


CONCLUSIONS
Three alternative research hypotheses were defined with at least a minimal level of support. Testing these hypotheses present substantial theoretical, methodological, and data analysis challenges.


CONCLUSIONS
Within a research framework, recommendations for change could achieve significant gains for understanding and for reducing breakdowns in care coordination.
Miller
Anne
A
Vanderbilt University Medical Center, Center for Perioperative Research in Quality, 1211 21st Avenue South, Nashville, TN 37212, USA. anne.miller@vanderbilt.edu
Scheinkestel
Carlos
C
Joseph
Michele
M
Hospital
Alfred
A
D003266:Continuity of Patient Care / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D008390:Markov Chains; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D017146:Models, Organizational