Teamwork and Team Cognition in the Intensive Care Unit

The intensive care unit (ICU) is one of the most complicated areas' of a hospital, with multidisciplinary teams providing life-saving care to critically ill patients. Root-cause analyses of medical errors in the rcu have indicated that poor teamwork and a lack of shared understanding between team members for aspects of patient care are important causal factors in medical errors. This thesis investigated teamwork and team cognition in the intensive care unit. Study 1 found teamwork to be important for sa'ty in the ICU. An analysis of critical incident studies showed that approximately 43% of the contributory factors underlying critical incidents in the ICU were related to 'non-technical skills'. Of those, 16% were associated with teamwork. Studies 2 investigated the influence of team structures upon the perceptions of ICU team members in the UK. The survey showed ICU staff at four ICUs to have positive perceptions of communication and leadership in the rcu. However, team member roles were found to influence perceptions, with nurses and junior doctors having less positive perceptions (compared to senior doctors) of communication and leadership in the rcu. Study 3 investigated a facet of team cognition known as team situation awareness (team SA). Regression analysis found minimal support for the hypothesis that the involvement and contributions of team members during patient reviews would predict the degree to which team members formed similar anticipations of future patient conditions (i.e. team SA). However, the involvement of trainee doctors in the patient decision-making process was found to predict the degree to which they formed similar anticipations with the senior doctor on two measures of situation awareness. The data presented in this thesis indicates the importance of teamwork for safety in the ICU, and identifies the factors (e.g. team hierarchies) that influence team process and team performance. Keywords: ICU, patient safety, medical error, teamwork, team cognition, team situation awareness.EThOS - Electronic Theses Online ServiceGBUnited Kingdo