title: Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.
abstract: BACKGROUND
  The awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle is a multicomponent complex intervention that improves outcomes for critically ill adults yet is inconsistently implemented. Effective interprofessional team function (how the team interacts) is key to ABCDE delivery but little is known about how to measure team interactions. The purpose of our study was to examine the reliability of an observational rating tool to assess team interactions about ABCDE in one ICU.
  
  
  RESULTS
  We pilot tested and evaluated reliability of an observational rating tool to assess team interactions about ABCDE. Two independent raters used this tool in one medical ICU over 4 weeks during morning rounds. We examined which ABCDE components were addressed, which team members initiated interactions, and which participated in interactions about ABCDE. We evaluated inter-rater reliability using Cohen's kappa statistic and data from interprofessional team interactions for 23 patients. We demonstrated moderate to substantial reliability for whether breathing, coordination, delirium or early mobility were addressed (k = 0.48-0.78) and slight to fair reliability for which team members initiated interactions about ABCDE (0.18-0.40). Reliability was low for whether Awakening was addressed (k = -0.07) and for which team members initiated interactions about awakening (k = 0.05).
  
  
  CONCLUSIONS
  Our study provides pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE. Future work should further test and modify this tool to gain an understanding of how to use team interactions to improve ABCDE delivery.
authors.affiliation: Department of Systems, Populations & Leadership, School of Nursing, University of Michigan, 400 North Ingalls 4351, Ann Arbor, MI, USA. dkcosta@umich.edu.
authors.forename: Deena Kelly
authors.initials: DK
authors.lastname: Costa
authors.affiliation: University of Michigan Hospital System, Ann Arbor, MI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dammeyer
authors.affiliation: Department of Systems, Populations & Leadership, School of Nursing, University of Michigan, 400 North Ingalls 4351, Ann Arbor, MI, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: White
authors.affiliation: Trinity Health System, Victor Parkway, Livonia, MI, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Galinato
authors.affiliation: University of Michigan Hospital System, Ann Arbor, MI, USA.|Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hyzy
authors.affiliation: Department of Systems, Populations & Leadership, School of Nursing, University of Michigan, 400 North Ingalls 4351, Ann Arbor, MI, USA.
authors.forename: Milisa
authors.initials: M
authors.lastname: Manojlovich
authors.affiliation: Department of Learning Health Systems, School of Medicine, University of Michigan, Ann Arbor, MI, USA.|Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Sales
mesh_terms: D003299:Cooperative Behavior; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D005791:Patient Care; D010865:Pilot Projects; D015203:Reproducibility of Results
keywords: Complex care delivery; Critical care; Mechanical ventilation; Teamwork