Interdisciplinary Critical Care Management: Comparing Models and Tools for Enhanced Teamwork

Teamwork within critical care settings is not merely beneficial—it’s the cornerstone of effective patient management and optimal outcomes. The intricate nature of critical care necessitates a collaborative, interdisciplinary approach, drawing upon the expertise of diverse healthcare professionals. Recognizing the paramount importance of team effectiveness, healthcare organizations have increasingly focused on implementing interventions designed to bolster team performance. This article delves into a comprehensive review of these interventions, comparing and contrasting various models and tools employed in interdisciplinary critical care management. By examining the landscape of team-based strategies, we aim to provide a robust understanding of the current best practices and future directions in optimizing critical care teamwork.

Training Models for Interdisciplinary Critical Care Teams

Effective teamwork is not inherent; it requires deliberate cultivation through targeted training. Various training models have emerged, each with distinct approaches to enhance interdisciplinary team performance in critical care. These models can be broadly categorized into principle-based training, method-based training, and general team training, each offering unique strengths and applications within the critical care environment.

Principle-Based Training: CRM vs. TeamSTEPPS

Among principle-based training models, Crew Resource Management (CRM) and TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) stand out as prominent frameworks. Both CRM and TeamSTEPPS are rooted in the concept of leveraging non-technical skills to improve team effectiveness and patient safety, yet they differ in their origins and specific emphasis.

Crew Resource Management (CRM): Originating in the aviation industry, CRM was developed to address human error in high-stakes environments. It emphasizes a suite of non-technical skills crucial for effective teamwork, including situational awareness, decision-making, communication, leadership, and stress management. In critical care, CRM training typically involves didactic sessions, case studies, role-playing, and simulation exercises designed to instill these core principles. Studies have shown that CRM training in critical care settings can lead to improvements in perceived teamwork ability, confidence during critical events, and enhanced safety climate. For instance, a study by Gore et al. (2010) demonstrated that CRM training in the operating room improved teamwork, error reporting, and safety climate.

TeamSTEPPS: Evolving from CRM and tailored specifically for healthcare, TeamSTEPPS is a systematic approach developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD). It provides a comprehensive framework for enhancing teamwork and communication skills among healthcare professionals. TeamSTEPPS emphasizes five key domains: team structure, leadership, situation monitoring, mutual support, and communication. Unlike CRM which is more conceptually focused, TeamSTEPPS offers a structured toolkit with specific strategies and techniques, such as SBAR (Situation, Background, Assessment, Recommendation) for communication, huddles for team briefings, and debriefs for post-event analysis. TeamSTEPPS training often incorporates didactic sessions, simulation exercises, and practical application of tools within the clinical setting. Research on TeamSTEPPS in critical care has consistently shown positive impacts on teamwork perceptions, communication effectiveness, and safety culture. For example, Capella et al. (2010) found that TeamSTEPPS implementation in a trauma center improved leadership, situation monitoring, mutual support, communication, and overall teamwork, while also reducing time to critical interventions.

Comparison and Contrast:

Feature	CRM	TeamSTEPPS
Origin	Aviation Industry	Healthcare-Specific Adaptation of CRM
Focus	Core Non-Technical Skills	Structured Tools & Techniques for Teamwork
Structure	Conceptual Framework	Toolkit with Specific Strategies & Tools
Emphasis	Human Factors, Error Management	Standardization, Change Management, Implementation
Critical Care Application	Broadly Applicable, Adaptable to Context	Highly Relevant, Tailored for Healthcare Teams

Both CRM and TeamSTEPPS offer valuable frameworks for enhancing interdisciplinary teamwork in critical care. CRM provides a strong foundation in the essential non-technical skills, while TeamSTEPPS offers a more structured and readily implementable approach with specific tools and techniques. The choice between CRM and TeamSTEPPS, or a hybrid approach, often depends on the specific needs and context of the critical care unit, organizational resources, and desired level of structure in the team training program.

PRISMA flowchart summarizing the study selection process, essential for transparency and replicability in systematic reviews.

Method-Based Training: Simulation in Critical Care

Simulation-based training has emerged as a powerful method for enhancing interdisciplinary teamwork in critical care. It provides a safe and controlled environment to replicate real-world clinical scenarios, allowing teams to practice technical and non-technical skills without risk to actual patients. Simulation in critical care can range from high-fidelity simulations using mannequins and realistic environments to virtual reality simulations and standardized patient encounters.

Types of Simulation:

• High-Fidelity Simulation: Utilizes advanced mannequins that can mimic physiological responses and realistic clinical environments, providing immersive and highly interactive training scenarios.
• In-Situ Simulation: Conducts simulations within the actual clinical environment (e.g., ICU, operating room), allowing teams to practice in their usual workspace and identify latent safety threats within their system.
• Virtual Reality Simulation: Employs computer-generated environments to create interactive scenarios, offering flexibility and accessibility for training.
• Standardized Patient Simulation: Utilizes trained actors to portray patients, focusing on communication skills, patient interaction, and clinical assessment.

Benefits of Simulation in Critical Care:

• Safe Practice Environment: Allows for practice of critical skills and team responses in a risk-free setting, promoting learning from errors without patient harm.
• Interdisciplinary Team Training: Facilitates training of diverse critical care teams together, fostering understanding of roles, improving communication, and enhancing coordination.
• Skill Development: Enhances both technical skills (e.g., intubation, resuscitation) and non-technical skills (e.g., teamwork, communication, leadership).
• Performance Assessment: Provides opportunities for objective assessment of team performance, identification of areas for improvement, and feedback for team development.
• System Improvement: In-situ simulation can uncover latent safety threats and system vulnerabilities within the critical care environment, leading to proactive system improvements.

Numerous studies have demonstrated the effectiveness of simulation-based training in critical care. For example, Auerbach et al. (2014) showed that in-situ interdisciplinary pediatric trauma simulation improved overall team performance, teamwork, and intubation skills in a tertiary care pediatric emergency department. Similarly, a meta-analysis by Murphy et al. (2016) concluded that simulation-based team training is an effective method for training resuscitation teams in crisis management and has the potential to improve team performance.

Comparison and Contrast:

Feature	High-Fidelity Simulation	In-Situ Simulation	Virtual Reality Simulation	Standardized Patient Simulation
Fidelity	High (Realistic Physiology & Environment)	High (Real Clinical Environment)	Medium (Computer-Generated Environment)	Medium (Actor Portrayal)
Environment	Simulation Lab	Actual Clinical Unit	Virtual Environment	Clinical Setting or Simulation Lab
Focus	Technical & Non-Technical Skills	System Integration, Latent Threat Detection	Flexibility, Accessibility, Skill Practice	Communication, Patient Interaction Skills
Cost	High (Equipment, Maintenance)	Medium (Logistics, Coordination)	Medium (Software, Development)	Low to Medium (Actor Training)
Critical Care Application	Complex Procedures, Crisis Management	System Testing, Teamwork in Real Setting	Skill Practice, Scenario Rehearsal	Communication Skills, Patient Scenarios

Simulation-based training offers a versatile and effective method for enhancing interdisciplinary teamwork in critical care. The choice of simulation modality depends on the specific training objectives, resources available, and the desired level of realism and system integration. In-situ simulation, in particular, provides a unique opportunity to improve teamwork within the actual critical care environment and identify system-based vulnerabilities that can be addressed proactively.

General Team Training in Critical Care

General team training encompasses a broad spectrum of interventions that aim to improve teamwork without adhering to a specific principle like CRM or TeamSTEPPS, or a single method like simulation. These programs often incorporate a mix of educational approaches, including didactic lectures, interactive workshops, team-building activities, and communication skills training. General team training programs are often tailored to address specific team needs and may focus on improving communication, conflict resolution, role clarity, and team cohesion within the critical care setting.

Characteristics of General Team Training:

• Eclectic Approach: Combines various educational methods and team-building activities.
• Customized Content: Tailored to address specific team needs and challenges identified within the critical care unit.
• Focus on Foundational Team Skills: Emphasizes core team skills such as communication, collaboration, conflict resolution, and role understanding.
• Team-Building Activities: May incorporate experiential learning exercises and team-building activities to enhance team cohesion and relationships.
• Flexibility: Allows for adaptation to different critical care team structures and settings.

Examples of general team training interventions in critical care include communication skills workshops, conflict management training, interprofessional education sessions, and team-building retreats. While general team training may lack the structured framework of principle-based models like CRM or TeamSTEPPS, it offers flexibility and can be tailored to address the unique needs of specific critical care teams. Studies evaluating general team training in critical care have shown improvements in team cohesion, communication openness, and perceived teamwork effectiveness. For instance, Blegen et al. (2010) found that multidisciplinary teamwork and communication training in inpatient medical units improved supervisor manager expectations, organizational learning, communication openness, and hospital handoffs and transitions.

Comparison and Contrast:

Feature	Principle-Based Training (CRM/TeamSTEPPS)	Method-Based Training (Simulation)	General Team Training
Framework	Structured, Principle-Driven	Method-Focused (Simulation)	Flexible, Eclectic Approach
Specificity	Specific Principles & Tools	Specific Training Method	Broad, Customizable Content
Focus	Non-Technical Skills, Error Management	Skill Development, Team Performance	Foundational Team Skills, Team Cohesion
Customization	Adaptable within Framework	Scenario-Based Customization	Highly Customizable to Team Needs
Critical Care Application	Standardized Approach, Core Skills	Skill Practice, Performance Improvement	Tailored Solutions, Team Dynamics

General team training provides a valuable approach for enhancing interdisciplinary teamwork in critical care, particularly when tailored to address specific team needs and challenges. While it may lack the structured framework of principle-based models or the immersive practice environment of simulation, general team training offers flexibility and can effectively build foundational team skills and improve team dynamics within the critical care setting. Often, a blended approach incorporating elements from principle-based, method-based, and general team training may be most effective in achieving comprehensive team development in critical care.

Summary of results from studies included in the systematic review, categorizing interventions, settings, outcomes, and evidence quality.

Tools for Structuring Interdisciplinary Critical Care Teamwork

Beyond training, specific tools can be implemented to structure and standardize teamwork processes in critical care, fostering more effective communication and coordination among interdisciplinary teams. These structuring tools aim to create predictable frameworks for team interactions, ensuring that critical information is shared, roles are clarified, and decisions are made collaboratively. Key structuring tools in critical care include SBAR, (de)briefing checklists, and structured rounds.

SBAR in Critical Care

SBAR (Situation, Background, Assessment, Recommendation) is a structured communication tool designed to standardize information exchange among healthcare professionals. It provides a concise and predictable format for presenting patient information, ensuring that all essential details are communicated effectively and efficiently. In critical care, SBAR can be used for various communication scenarios, including patient handoffs, consultations, escalation of concerns, and daily team updates.

Components of SBAR:

• Situation: Briefly describe the current situation or problem. (e.g., “Patient is experiencing increased respiratory distress.”)
• Background: Provide relevant background information related to the situation. (e.g., “Patient is a 70-year-old male with a history of COPD, admitted for pneumonia three days ago.”)
• Assessment: State your clinical assessment of the situation. (e.g., “Patient’s oxygen saturation is now 88% on FiO2 of 0.5, and he is using accessory muscles.”)
• Recommendation: Clearly state your recommendation or request. (e.g., “I recommend we consider escalating respiratory support to non-invasive ventilation.”)

Benefits of SBAR in Critical Care:

• Standardized Communication: Provides a common language and structure for communication, reducing ambiguity and miscommunication.
• Improved Efficiency: Facilitates concise and focused communication, saving time and improving workflow.
• Enhanced Patient Safety: Ensures that critical information is consistently communicated, reducing the risk of errors and omissions.
• Interdisciplinary Collaboration: Provides a framework for effective communication across different disciplines within the critical care team.
• Assertiveness and Escalation: Empowers team members to communicate concerns and escalate issues effectively.

Numerous studies have demonstrated the positive impact of SBAR implementation in healthcare settings, including critical care. For example, Beckett et al. (2009) found that SBAR Collaborative Communication Education in a hospital pediatrics/perinatal services department improved communication, collaboration, satisfaction, and patient safety outcomes. Martin et al. (2015) showed that huddles structured with SBAR in a pediatric emergency department improved teamwork, communication, and nursing satisfaction.

Comparison and Contrast:

Feature	SBAR	Unstructured Communication
Structure	Highly Structured, Predictable Format	Unstructured, Free-Form
Conciseness	Concise and Focused	Can be Verbose and Rambling
Clarity	Clear and Unambiguous	Potential for Ambiguity and Misinterpretation
Completeness	Prompts for Essential Information	Risk of Omission of Critical Information
Efficiency	Time-Saving, Streamlined Workflow	Can be Time-Consuming and Inefficient
Interdisciplinary Application	Universal Language, Cross-Disciplinary Use	May Vary Across Disciplines
Critical Care Application	Handovers, Consultations, Escalations	Daily Updates, Informal Communication

SBAR provides a valuable structuring tool for interdisciplinary communication in critical care. By standardizing information exchange, SBAR enhances clarity, efficiency, and patient safety. Compared to unstructured communication, SBAR promotes a more focused and predictable approach, ensuring that critical information is consistently conveyed and understood across the interdisciplinary critical care team. However, effective SBAR implementation requires training, reinforcement, and integration into the clinical workflow to ensure consistent and meaningful use.

(De)briefing Checklists in Critical Care

(De)briefing checklists are another crucial structuring tool for interdisciplinary teamwork in critical care. Briefings, conducted before a procedure or shift, proactively align the team on goals, roles, and potential challenges. Debriefings, held after an event or shift, provide a structured opportunity for reflection, learning from experiences, and identifying areas for improvement. Checklists provide a standardized format for both briefings and debriefings, ensuring that key topics are consistently addressed.

Types of Checklists:

• Pre-Procedure Briefing Checklists: Used before procedures (e.g., surgery, intubation) to confirm patient identity, procedure details, roles and responsibilities, and potential risks.
• Shift Briefing Checklists: Used at the start of shifts to review patient status, anticipate workload, and plan team assignments.
• Post-Event Debriefing Checklists: Used after critical events or simulations to review team performance, identify successes and areas for improvement, and reinforce learning.
• Shift Debriefing Checklists: Used at the end of shifts to summarize key events, identify unresolved issues, and facilitate smooth handoffs.

Benefits of (De)briefing Checklists in Critical Care:

• Proactive Team Alignment: Briefings ensure that the team starts with a shared understanding of goals, roles, and plans.
• Structured Reflection and Learning: Debriefings facilitate systematic review of team performance, promoting learning from both successes and errors.
• Improved Communication: Checklists provide prompts for key communication points, ensuring essential information is shared.
• Enhanced Situational Awareness: Briefings and debriefings contribute to shared situational awareness within the team.
• Error Reduction: Proactive planning and post-event analysis can help prevent errors and improve patient safety.
• Team Development: Regular briefings and debriefings foster a culture of teamwork, communication, and continuous improvement.

Studies on (de)briefing checklists in critical care and other healthcare settings have demonstrated their effectiveness in improving teamwork and patient safety. For example, Berenholtz et al. (2009) showed that a standardized one-page briefing and debriefing tool in the operating room improved interdisciplinary communication and teamwork. Bliss et al. (2012) found that a comprehensive surgical safety checklist, including pre-operative briefing and post-operative debriefing checklists, decreased 30-day morbidity in surgical cases.

Comparison and Contrast:

Feature	(De)briefing Checklists	Ad Hoc Team Meetings
Structure	Structured, Checklist-Guided	Unstructured, Informal Meetings
Proactiveness	Briefings are Proactive, Debriefings Reactive	Meetings May be Reactive or Unplanned
Focus	Specific Topics, Key Information Prompts	Topic Varies, May Lack Focus
Regularity	Designed for Regular, Consistent Use	Meetings May be Infrequent or Inconsistent
Learning Cycle	Debriefings Enable Learning and Improvement	Learning May be Incidental, Not Systematized
Critical Care Application	Pre-Procedure Briefings, Shift Debriefings	Team Huddles, Ad Hoc Problem Solving

(De)briefing checklists provide a powerful structuring tool for interdisciplinary teamwork in critical care. By standardizing pre-shift planning and post-event reflection, checklists promote proactive team alignment, systematic learning, and continuous improvement. Compared to ad hoc team meetings, checklists offer a more focused, regular, and structured approach to team communication and development, ultimately contributing to enhanced patient safety and team effectiveness. Successful implementation requires training, integration into workflow, and a culture that values open communication and reflection.

Rounds in Critical Care

Structured interdisciplinary rounds represent another essential structuring tool for critical care teamwork. Rounds provide a dedicated time and format for the interdisciplinary team to meet at the patient’s bedside, review patient status, discuss care plans, and make collaborative decisions. Structured rounds ensure that all team members are informed, contribute to the care plan, and are aligned on patient goals.

Key Elements of Structured Rounds:

• Interdisciplinary Participation: Involves physicians, nurses, pharmacists, respiratory therapists, and other relevant disciplines.
• Bedside Format: Conducted at the patient’s bedside, allowing for direct patient assessment and family involvement.
• Standardized Agenda: Follows a structured format to ensure consistent review of key patient information and care plan elements.
• Active Team Participation: Encourages active participation from all team members, fostering shared decision-making.
• Documentation and Follow-Up: Decisions and action items are documented and followed up on to ensure implementation.

Benefits of Structured Rounds in Critical Care:

• Improved Communication: Provides a dedicated forum for interdisciplinary communication and information sharing.
• Shared Decision-Making: Fosters collaborative decision-making and care planning among the team.
• Enhanced Care Coordination: Improves coordination of care and ensures all team members are aligned on the care plan.
• Increased Efficiency: Streamlines communication and decision-making, potentially reducing redundant communication and delays.
• Patient and Family Involvement: Bedside rounds offer opportunities for patient and family involvement in care discussions.
• Team Cohesion: Regular rounds foster team cohesion and improve interdisciplinary relationships.

Studies have shown that structured interdisciplinary rounds in critical care and other inpatient settings can improve teamwork, communication, and patient outcomes. For instance, O’Leary et al. (2010) found that structured interdisciplinary rounds in a tertiary care teaching hospital improved teamwork climate compared to a control group. Li et al. (2018) demonstrated that structured daily rounds in an academic medical center improved communication among team members, saved time, and reduced 30-day readmissions.

Comparison and Contrast:

Feature	Structured Interdisciplinary Rounds	Traditional Medical Rounds
Disciplines	Interdisciplinary Team Participation	Primarily Physician-Led, Nurse Input Limited
Location	Bedside Rounds	May be Conducted Away from Bedside
Agenda	Standardized, Structured Agenda	Variable Agenda, Physician-Driven
Participation	Active Participation from All Disciplines	Nurse Participation Often Passive or Limited
Decision-Making	Shared Decision-Making	Physician-Centric Decision-Making
Patient Focus	Direct Patient Assessment at Bedside	Patient Assessment May be Indirect
Critical Care Application	Daily Patient Review, Care Planning	Progress Notes, Physician-Driven Updates

Structured interdisciplinary rounds offer a powerful structuring tool for critical care teamwork. By providing a dedicated time and format for interdisciplinary communication and collaborative decision-making at the bedside, rounds enhance care coordination, improve communication, and foster team cohesion. Compared to traditional medical rounds, structured rounds are more inclusive, patient-centered, and team-oriented, ultimately contributing to more effective and coordinated critical care. Successful implementation requires commitment from all disciplines, training on the structured format, and integration into the daily workflow of the critical care unit.

Categorization of team interventions from the systematic review, detailing the number of studies and descriptions for each category and subcategory.

Tools for Facilitating and Triggering Interdisciplinary Critical Care Teamwork

In addition to structuring tools, other types of tools can facilitate and trigger interdisciplinary teamwork in critical care. Facilitating tools often leverage technology to enhance communication and information sharing, while triggering tools use information provision and monitoring to incentivize team interaction and performance improvement.

Technology for Facilitation

Technology plays an increasingly important role in facilitating interdisciplinary teamwork in critical care. Telemedicine, communication platforms, and mobile task management tools offer avenues to enhance communication, information sharing, and remote collaboration among critical care team members.

Types of Facilitating Technologies:

• Tele-ICU (Telemedicine for Intensive Care): Utilizes remote monitoring and communication technology to connect intensivists and critical care nurses at a central hub with bedside teams in remote ICUs. Tele-ICU facilitates remote consultation, real-time monitoring, and expert support, enhancing access to specialized critical care expertise.
• Communication Platforms: Secure messaging platforms, video conferencing tools, and integrated communication systems facilitate rapid and efficient communication among team members, regardless of location. These platforms can improve responsiveness, reduce communication delays, and enhance information sharing.
• Mobile Task Management Tools: Mobile applications and digital platforms designed to digitize patient flow, track tasks, and provide real-time visibility of clinical decision-making and task performance. These tools can improve workflow efficiency, task coordination, and team awareness of patient status.
• Electronic Health Records (EHRs) and Clinical Decision Support Systems (CDSS): While primarily designed for patient documentation and clinical management, EHRs and integrated CDSS can facilitate teamwork by providing a shared platform for information access, care planning, and clinical decision support.

Benefits of Technology for Facilitation in Critical Care:

• Improved Communication Efficiency: Technology can streamline communication, reduce delays, and improve responsiveness.
• Enhanced Information Sharing: Digital platforms facilitate rapid and widespread dissemination of patient information, care plans, and updates.
• Remote Collaboration: Telemedicine and communication technologies enable remote consultation, expert support, and collaboration across geographical distances.
• Workflow Optimization: Mobile task management tools and EHR integration can improve workflow efficiency, task coordination, and team awareness.
• Increased Access to Expertise: Tele-ICU and remote consultation expand access to specialized critical care expertise, particularly for smaller or rural hospitals.

Studies evaluating technology-based facilitation tools in critical care have shown positive impacts on teamwork and communication. For example, Chu-Weininger et al. (2010) found that remote monitoring by intensivists using telemedicine technology (tele-ICU) improved teamwork climate and safety climate in intensive care units. Foo et al. (2015) demonstrated that a mobile task management tool improved working efficiency of junior clinical staff in an acute general surgical service.

Comparison and Contrast:

Feature	Technology-Facilitated Teamwork	Traditional Teamwork Communication
Communication Mode	Digital, Electronic Platforms	Primarily Verbal, Face-to-Face, Paper-Based
Speed	Rapid, Real-Time Communication	Potential for Delays, Time Lag
Information Access	Broad, Centralized Information Sharing	Information May be Siloed, Fragmented
Location Barrier	Overcomes Geographical Barriers	Communication Limited by Location
Efficiency	Streamlines Communication, Workflow	Potential for Inefficiency, Redundancy
Critical Care Application	Tele-ICU, Remote Consultation, Task Tracking	Handovers, Verbal Orders, Chart Reviews

Technology offers powerful tools to facilitate interdisciplinary teamwork in critical care. By leveraging digital platforms for communication, information sharing, and remote collaboration, technology can enhance efficiency, responsiveness, and access to expertise. Compared to traditional communication methods, technology-facilitated teamwork can overcome geographical barriers, streamline workflows, and improve information flow within the critical care team. However, successful implementation requires careful planning, user training, and integration into the clinical workflow to ensure technology enhances, rather than hinders, team interactions and patient care.

Triggering Tools

Triggering tools aim to incentivize and promote effective teamwork by providing information, feedback, and mechanisms for shared reflection. These tools often involve monitoring team performance, visualizing data, and creating opportunities for teams to reflect on their processes and identify areas for improvement.

Types of Triggering Tools:

• Clinical Dashboards: Visual displays of key performance indicators (KPIs), patient outcomes, and team performance metrics. Dashboards provide real-time feedback on team performance, allowing teams to monitor progress, identify trends, and trigger discussions about areas needing attention.
• Scorecards and Performance Reports: Regular reports summarizing team performance data, comparing performance against targets or benchmarks. Scorecards can incentivize teams to focus on improvement goals and track progress over time.
• Concept Mapping: Visual tools used to represent complex patient situations, care plans, or team processes. Concept mapping can facilitate shared understanding, promote team discussion, and trigger collaborative problem-solving.
• Shared Reflection Activities: Structured activities designed to promote team reflection, such as “Thought for the Day” interventions, case-based discussions, or story sharing. These activities can foster team bonding, enhance compassion, and trigger deeper reflection on team processes and patient care.

Benefits of Triggering Tools in Critical Care:

• Performance Monitoring and Feedback: Dashboards and scorecards provide data-driven feedback on team performance, motivating teams to strive for improvement.
• Data-Driven Decision-Making: Information provided by triggering tools can inform team discussions, guide quality improvement initiatives, and support data-driven decision-making.
• Shared Awareness and Understanding: Concept mapping and shared reflection activities promote shared understanding of complex situations and team processes.
• Team Motivation and Engagement: Feedback, recognition, and opportunities for reflection can enhance team motivation and engagement in quality improvement efforts.
• Continuous Improvement Culture: Triggering tools can contribute to a culture of continuous improvement by encouraging teams to regularly review their performance, identify areas for growth, and implement changes.

Studies evaluating triggering tools in healthcare settings have shown positive impacts on teamwork and performance. For example, Stoller et al. (2010) found that a respiratory therapy (RT) business scorecard, comparing target goals with actual monthly performance, improved teamwork among RT departments and patient outcomes. O’Neil et al. (2017) demonstrated that a “Thought for the Day” intervention, involving a short reflection on poetry or music, improved perception of teamwork in an inpatient palliative care unit.

Comparison and Contrast:

Feature	Triggering Tools	Passive Performance Monitoring
Purpose	Incentivize Teamwork, Promote Reflection	Primarily Data Collection, Performance Tracking
Feedback	Active Feedback, Data Visualization	Passive Data Reporting, Limited Feedback
Team Engagement	Designed to Engage Teams in Improvement	May Not Actively Engage Teams
Reflection	Promotes Structured Team Reflection	Limited Emphasis on Team Reflection
Action Orientation	Actionable Insights, Improvement Focus	Data May Not Translate to Actionable Steps
Critical Care Application	Dashboards, Scorecards, Reflection Activities	Routine Data Collection, Quality Reporting

Triggering tools offer a valuable approach to promote interdisciplinary teamwork in critical care by providing feedback, incentivizing improvement, and fostering shared reflection. Compared to passive performance monitoring, triggering tools are designed to actively engage teams in quality improvement efforts, providing actionable insights and promoting a culture of continuous learning. Effective implementation requires careful selection of relevant metrics, user-friendly data visualization, and facilitation of team discussions and action planning based on the information provided by triggering tools.

Organizational (Re)design for Interdisciplinary Critical Care

Beyond training and tools, organizational redesign interventions aim to improve interdisciplinary teamwork by modifying structures, processes, and roles within the critical care unit or healthcare organization. These interventions focus on creating an environment that supports and fosters effective team functioning.

Types of Organizational Redesign Interventions:

• Care Pathways and Standardized Processes: Implementing standardized care pathways and protocols to streamline workflows, clarify roles, and improve coordination of care for specific patient populations. Standardized processes can reduce variability, improve predictability, and enhance team collaboration.
• Role Redesign and Task Shifting: Re-evaluating and redesigning roles within the interdisciplinary team to optimize skill utilization, improve workflow efficiency, and enhance team function. Task shifting, such as delegating tasks from physicians to nurses or other professionals, can improve team efficiency and satisfaction.
• Team-Based Payment Models: Shifting from fee-for-service payment models to team-based payment models that incentivize collaboration, quality, and patient outcomes. Team-based payment models can encourage team-oriented care delivery and promote shared accountability.
• Physical Environment Redesign: Modifying the physical layout and design of the critical care unit to improve communication, workflow, and team interaction. Redesigning unit layout, co-locating team members, and creating dedicated team spaces can enhance collaboration and efficiency.
• Dedicated Interdisciplinary Teams: Establishing dedicated interdisciplinary teams focused on specific patient populations or care areas. Dedicated teams can foster team cohesion, improve communication, and enhance continuity of care.

Benefits of Organizational Redesign in Critical Care:

• Improved Workflow Efficiency: Standardized processes and role redesign can streamline workflows, reduce redundancy, and improve team efficiency.
• Enhanced Role Clarity and Accountability: Defined roles and standardized processes clarify responsibilities and improve accountability within the team.
• Better Care Coordination: Organizational redesign interventions can improve coordination of care and ensure seamless transitions across team members and disciplines.
• Increased Team Satisfaction: Optimized workflows, role clarity, and team-based models can improve team satisfaction and reduce burnout.
• Enhanced Patient Outcomes: Improved teamwork, efficiency, and care coordination can contribute to better patient outcomes and safety.

Studies evaluating organizational redesign interventions in healthcare settings have shown positive impacts on teamwork and performance. For example, de Beijer et al. (2016) found that clinical pathways in an orthopedic hand unit outpatient clinic improved communication and collaborative problem-solving skills. Hung et al. (2018) demonstrated that redesigning workflows in ambulatory care primary care departments improved teamwork, physician participation in decisions, and staff engagement.

Comparison and Contrast:

Feature	Organizational Redesign	Incremental Process Improvement
Scope	System-Wide, Structural Changes	Localized, Gradual Adjustments
Impact	Transformational, Fundamental Change	Evolutionary, Incremental Change
Implementation	Complex, Requires Significant Planning	Simpler, More Adaptable Implementation
Timeframe	Longer-Term Implementation and Impact	Shorter-Term Implementation and Impact
Resource Intensity	Higher Resource Requirements	Lower Resource Requirements
Critical Care Application	Care Pathways, Role Redesign, Team Models	Workflow Adjustments, Local Protocol Changes

Organizational redesign offers a powerful approach to improve interdisciplinary teamwork in critical care by fundamentally reshaping structures, processes, and roles. Compared to incremental process improvement, organizational redesign is more transformative, aiming for system-wide changes that create a supportive environment for effective team functioning. However, organizational redesign interventions are often complex, require significant planning and resources, and may involve longer implementation timeframes. Successful implementation requires strong leadership support, interdisciplinary collaboration in the redesign process, and careful consideration of the specific context and needs of the critical care unit and healthcare organization.

Programmatic Approaches to Interdisciplinary Critical Care Teamwork

Programmatic approaches represent a comprehensive strategy for improving interdisciplinary teamwork in critical care by combining multiple interventions into a cohesive and sustained program. These programs typically integrate training, tools, and organizational redesign elements, often tailored to address specific needs and priorities within the critical care setting.

Characteristics of Programmatic Approaches:

• Multicomponent Interventions: Combine multiple types of interventions, such as training, tools, and organizational redesign.
• Tailored to Context: Programs are often customized to address the specific needs, challenges, and context of the critical care unit or healthcare organization.
• Sustained Implementation: Programmatic approaches emphasize long-term implementation, reinforcement, and sustainability of interventions.
• Quality Improvement Framework: Often integrated within a quality improvement framework, incorporating data collection, performance monitoring, and continuous improvement cycles.
• Leadership Engagement: Require strong leadership support and engagement to drive program implementation and sustain changes.

Examples of Programmatic Approaches:

• Comprehensive Unit-Based Safety Program (CUSP): A widely implemented program that combines safety science education, executive partnership, learning from defects, and implementation of teamwork tools. CUSP aims to improve safety culture and reduce preventable harm in various healthcare settings, including critical care.
• Medical Team Training (MTT) Programs: Programs based on CRM principles that incorporate training, implementation of teamwork tools (e.g., briefings, debriefings, SBAR), and follow-up coaching. MTT programs aim to enhance team performance and improve patient safety in various clinical settings.
• Safety Program for Surgery (SPS): A program combining CUSP principles with individualized bundles of interventions tailored to surgical settings. SPS aims to improve patient safety and teamwork in the operating room and perioperative environment.
• Transforming Care at the Bedside (TCAB): A program focused on empowering frontline staff to improve care processes at the bedside. TCAB often incorporates team training, process redesign, and implementation of tools to enhance teamwork, efficiency, and patient satisfaction.

Benefits of Programmatic Approaches in Critical Care:

• Synergistic Effects: Combining multiple interventions can create synergistic effects, maximizing the impact on teamwork and patient outcomes.
• Comprehensive Improvement: Programmatic approaches address multiple facets of teamwork, fostering more comprehensive and sustainable improvement.
• Context-Specific Solutions: Tailoring programs to specific contexts ensures relevance and increases the likelihood of successful implementation.
• Long-Term Sustainability: Programmatic approaches emphasize sustained implementation and continuous improvement, promoting long-term impact.
• Culture Change: Comprehensive programs can foster a culture of teamwork, safety, and continuous improvement within the critical care unit and organization.

Studies evaluating programmatic approaches in critical care and other healthcare settings have shown significant improvements in teamwork, safety culture, and patient outcomes. For example, Pronovost et al. (2008) demonstrated that CUSP implementation in intensive care units improved teamwork climate. Neily et al. (2010) found that an MTT program in surgical care within Veterans Health Administration improved teamwork, efficiency, and reduced surgical mortality.

Comparison and Contrast:

Feature	Programmatic Approaches	Standalone Interventions
Scope	Comprehensive, Multicomponent	Focused, Single or Limited Interventions
Integration	Integrated Set of Interventions	Standalone, Less Integrated Interventions
Customization	Tailored to Specific Contexts	May be Generic, Less Context-Specific
Sustainability	Emphasizes Long-Term Sustainability	Sustainability May be Less Emphasized
Impact Potential	Higher Potential for Broad, Sustained Impact	Potential Impact May be More Limited
Critical Care Application	CUSP, MTT, SPS, TCAB Programs	Isolated Training, Tool Implementation

Programmatic approaches offer the most comprehensive and potentially impactful strategy for improving interdisciplinary teamwork in critical care. By integrating multiple interventions, tailoring programs to specific contexts, and emphasizing sustained implementation, programmatic approaches can create synergistic effects and foster a culture of teamwork, safety, and continuous improvement. Compared to standalone interventions, programmatic approaches offer a more holistic and long-term solution to enhancing interdisciplinary team performance in the complex and demanding environment of critical care. However, programmatic approaches require significant commitment, resources, and leadership support for successful design, implementation, and sustained impact.

Conclusion

This review highlights the diverse landscape of models and tools available to enhance interdisciplinary critical care management. From foundational training programs like CRM and TeamSTEPPS to structuring tools like SBAR and checklists, and from technology-facilitated communication to comprehensive programmatic approaches, healthcare organizations have a wide array of options to improve teamwork and ultimately, patient care.

Key Comparisons and Contrasts:

• Training Models: Principle-based training (CRM/TeamSTEPPS) provides a structured framework for non-technical skills, simulation offers a safe practice environment, and general team training allows for customized skill-building.
• Structuring Tools: SBAR standardizes communication, (de)briefing checklists promote proactive planning and reflection, and structured rounds facilitate interdisciplinary discussion and decision-making.
• Facilitating and Triggering Tools: Technology enhances communication and information sharing, while triggering tools provide feedback and incentivize team improvement.
• Organizational Redesign: Offers system-wide changes to create a supportive environment for teamwork, while programmatic approaches integrate multiple interventions for comprehensive and sustained impact.

Choosing the Right Approach:

The optimal approach for enhancing interdisciplinary critical care teamwork is not one-size-fits-all. The selection of models and tools should be guided by a careful assessment of the specific needs, challenges, and context of the critical care unit and healthcare organization. Factors to consider include:

• Specific Team Needs: Identify areas where teamwork needs improvement (e.g., communication, conflict resolution, role clarity).
• Organizational Culture: Consider the existing culture and readiness for change.
• Resources Available: Assess the resources available for training, tool implementation, and organizational redesign.
• Desired Level of Structure: Determine the appropriate level of structure and standardization needed for team processes.
• Sustainability Goals: Prioritize interventions that can be sustained over time and integrated into routine clinical practice.

Future Directions:

Future research should focus on:

• Long-Term Impact: Investigating the long-term effects of team interventions on patient outcomes, team performance, and professional well-being.
• Contextual Factors: Exploring how contextual factors influence the effectiveness of different team interventions in diverse critical care settings.
• Programmatic Approaches: Further developing and evaluating comprehensive programmatic approaches that integrate multiple interventions and address system-level factors.
• Technology Integration: Optimizing the use of technology to facilitate and enhance interdisciplinary teamwork in critical care.
• Outcome Measures: Expanding the range of outcome measures beyond patient safety to include team satisfaction, professional well-being, and efficiency metrics.

By continuously evaluating and refining our approaches to interdisciplinary critical care management, we can strive towards creating high-performing teams that deliver the best possible care for critically ill patients. The ongoing evolution of models and tools, coupled with rigorous research and thoughtful implementation, holds the key to unlocking the full potential of interdisciplinary teamwork in critical care.

References

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