Log in | Register

Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale

Elsbeth C. M. Ten Have| Raoul E. Nap| Jaap E. Tulleken
Original Article
Volume 39, Issue 10 / October , 2013

Pages 1800 - 1807

Abstract

Purpose

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of leadership training on the quality of IDRs in the ICU.

Methods

A nonrandomized intervention study was conducted in four ICUs for adults. The intervention was a 1-day training session in a simulation environment and workplace-based feedback sessions. Measurement included 28 videotaped IDRs (total, 297 patient presentations) that were assessed with 10 essential quality indicators of the validated IDR Assessment Scale. Participants were 19 intensivists who previously had no formal training in leading IDRs. They were subdivided by cluster sampling into a control group (ten experienced intensivists) and intervention group (nine intensive care fellows). Mann–Whitney U test was used to compare results between control and intervention groups.

Results

Baseline measurements of control and intervention groups revealed two indicators that differed significantly. The frequency of yes ratings for the intervention group significantly increased for seven of the ten indicators from before to after intervention. The frequency of yes ratings after training was significantly greater in the intervention than control groups for eight of the ten essential quality indicators.

Conclusions

The leadership training improved the quality of the IDRs performed in the ICUs. This may improve quality and safety of patient care.

Keywords

References

  1. Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, Kane-Gill SL, Kirchhoff KT, Levy M, Mitchell PH, Moreno R, Pronovost P, Puntillo K (2006) Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med 34:211–218
    • View reference on PubMed
    • View reference on publisher's website
  2. Ten Have EC, Tulleken JE (2013) Leadership training and quality improvement of interdisciplinary rounds in the intensive care units. Crit Care 17(Suppl 2):522. doi:10.1186/cc12460
  3. Verma AA, Bohnen JD (2012) Bridging the leadership development gap: recommendations for medical education. Acad Med 87:549–550
    • View reference on PubMed
    • View reference on publisher's website
  4. Reader TW, Flin R, Mearns K, Cuthbertson BH (2009) Developing a team performance framework for the intensive care unit. Crit Care Med 37:1787–1793
    • View reference on PubMed
    • View reference on publisher's website
  5. Reader TW, Flin R, Cuthbertson BH (2011) Team leadership in the intensive care unit: the perspective of specialists. Crit Care Med 39:1683–1691
    • View reference on PubMed
    • View reference on publisher's website
  6. Stockwell DC, Slonim AD, Pollack MM (2007) Physician team management affects goal achievement in the intensive care unit. Pediatr Crit Care Med 8:540–545
    • View reference on PubMed
    • View reference on publisher's website
  7. Manser T (2009) Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 53:143–151
    • View reference on PubMed
    • View reference on publisher's website
  8. Malling B, Mortensen L, Bonderup T, Scherpbier A, Ringsted C (2009) Combining a leadership course and multi-source feedback has no effect on leadership skills of leaders in postgraduate medical education. An intervention study with a control group. BMC Med Educ 9:72
    • View reference on PubMed
    • View reference on publisher's website
  9. Hunziker S, Bühlmann C, Tschan F, Balestra G, Legeret C, Schumacher C, Semmer NK, Hunziker P, Marsch S (2010) Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med 38:1086–1091
    • View reference on PubMed
    • View reference on publisher's website
  10. Swanwick T, McKimm J (2011) What is clinical leadership… and why is it important? Clin Teach 8:22–26
    • View reference on PubMed
    • View reference on publisher's website
  11. Hunziker S, Laschinger L, Portmann-Schwarz S, Semmer NK, Tschan F, Marsch S (2011) Perceived stress and team performance during a simulated resuscitation. Intensive Care Med 37:1473–1479
  12. Streiff S, Tschan F, Hunziker S, Buehlmann C, Semmer NK, Hunziker P, Marsch S (2011) Leadership in medical emergencies depends on gender and personality. Simul Healthc 6:78–83
    • View reference on PubMed
    • View reference on publisher's website
  13. Ten Have EC, Hagedoorn M, Holman ND, Nap RE, Sanderman R, Tulleken JE (2013) Assessing the quality of interdisciplinary rounds in the intensive care unit. J Crit Care. doi:10.1016/j.jcrc.2012.12.007
    • View reference on PubMed
  14. Ten Have ECM, Nap RE (2013) Mutual agreement between providers in intensive care medicine on patient care after interdisciplinary rounds. J Intensive Care Med. doi:10.1177/0885066613486596
  15. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM (2010) The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med 22:369–376
  16. Azoulay E, Timsit JF, Sprung CL et al (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180:853–860
    • View reference on PubMed
    • View reference on publisher's website
  17. Rhodes A, Moreno RP, Azoulay E et al (2012) Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 38:598–605
  18. Reader T, Flin R, Lauche K, Cuthbertson BH (2006) Non-technical skills in the intensive care unit. Br J Anaesth 96:551–559
    • View reference on PubMed
    • View reference on publisher's website
  19. Ellrodt G, Glasener R, Cadorette B et al (2007) Multidisciplinary rounds (MDR): an implementation system for sustained improvement in the American Heart Association’s Get With The Guidelines program. Crit Pathw Cardiol 6:106–116
    • View reference on PubMed
    • View reference on publisher's website
  20. CoBaTrICE Collaboration (2011) International standards for programmes of training in intensive care medicine in Europe. Intensive Care Med 37:385–393
  21. CoBaTrICE Collaboration, Bion JF, Barrett H (2006) Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 32:1371–1383
  22. Boyle DK, Kochinda C (2004) Enhancing collaborative communication of nurse and physician leadership in two intensive care units. J Nurs Adm 34:60–70
    • View reference on PubMed
    • View reference on publisher's website
  23. Have EC, Tulleken JE (2013) Assessing the quality of interdisciplinary rounds. Crit Care 17(Suppl 2):P521. doi:10.1186/cc12459
    • View reference on publisher's website
  24. Randolph JJ (2008) Online kappa calculator. http://justusrandolph.net/kappa. Accessed 1 Dec 2011
  25. Randolph JJ (2005) Free-marginal multirater kappa: an alternative to Fleiss’ fixed-marginal multirater kappa. Joensuu University Learning and Instruction Symposium 2005. ERIC Document Reproduction Service No. ED490661
  26. Hawthorne G, Richardson J, Osborne R (1999) The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 8:209–224
    • View reference on PubMed
    • View reference on publisher's website
  27. Hair JF, Tatham RL, Anderson R (2005) Multivariate data analysis. Prentice-Hall, New Jersey
  28. van Mook WN, de Grave WS, Gorter SL, Muijtjens AM, Zwaveling JH, Schuwirth LW, van der Vleuten CP (2010) Fellows’ in intensive care medicine views on professionalism and how they learn it. Intensive Care Med 36:296–303
  29. Veronesi MC, Gunderman RB (2012) Perspective: the potential of student organizations for developing leadership: one school’s experience. Acad Med 87:226–229
    • View reference on PubMed
    • View reference on publisher's website
  30. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 3:CD002213
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement