Jay Cowen, MD, FCCM
Joanne Lindberg, MN, RN, CCRN
Andrew Egol, DO, MBA, FCCM
Thomas Rainey, MD, FCCM
Jay Cowen, MD, FCCM
Joanne Lindberg, MN, RN, CCRN
Andrew Egol, DO, MBA, FCCM

Consider this scenario: You are a staff member in a busy intensive care unit (ICU). As you enter the unit to start your shift, a quick glance at the census board makes you shudder. There are no open spaces on the board, and you know immediately that it is going to be a challenging day. You have arrived before 7:00 a.m., the noise level is already soaring, you can’t find an empty seat in which to conduct a report, and the tension is palpable. You are finally able to capture a small section of counter space and begin to discuss the patients, some of whose conditions are very complex.

One of your assigned patients was admitted two days ago for hypertensive urgency and is improving rapidly. The person’s blood pressure has been well controlled on a continuous infusion of antihypertensive therapy since early yesterday afternoon. This particular medication cannot be managed outside the ICU, so the patient remains in the unit despite the limited number of beds available. Because there are many sicker patients to discuss, this case receives only brief attention during the report.

The goal for that patient during the shift or for that day was not very clearly expressed. With an appropriate transition to oral medications, the patient could be transferred out of the ICU, yet this process has not been initiated. This particular patient has been at bed rest since ICU admission and he has not been receiving any form of prophylaxis against deep venous thrombosis (DVT). Without clear goals in mind, the patient may spend yet another sedentary day in the ICU, adding risk of complications such as DVT, and adding cost to this episode of care. How can this scenario improve when the multiprofessional team rounds procedure using the daily goals sheet has not been implemented?

Communicating effectively can be especially challenging for those working in high stress, fast paced environments such as the ICU. How can communication among the healthcare providers from many disciplines caring for critically ill patients be fostered so that the patients receive high quality care with minimal errors?

Multiprofessional teams working in the critical care setting require specialized tools to cultivate clear and concise communication within the group. Some examples of these tools include: active listening, positive voice tone, reiteration to confirm understanding and written summaries reflecting the content of a discussion (e.g., daily goal sheets).

As a team member delivering the message, you want to be certain that your colleagues have understood your intent. By using these tools you are able to ensure that your message has been delivered and comprehended, and you will reduce miscommunication and errors. As a team member listening to the message, you should ask questions for clarity and understanding. Make use of queries that begin with who, what or how? For example, how might a daily goals sheet help us care for the patient with hypertensive urgency? Active listening with attention to detail and clarity is as important as effective delivery of the message. Both of these components are important to ensure successful sharing of information.

The ability to guarantee accurate flow of information between various disciplines is also essential. The distribution of complex patient information among disciplines is a constant challenge in the ICU. Taking time to contact each team member individually to inform them of the plan of care creates redundancy and leads to lost time. Compilation of the daily action plan for each of the disciplines involved necessitates numerous discussions with colleagues who may have varying degrees of accessibility. This is also true when attempting to contact team members who are in other parts of the hospital or who are absent from the ICU.

A useful method to promote clear, concise communication within multiprofessional teams is to develop and implement team rounds and daily goal sheets. Using this approach in the critical care setting provides the team with thoughtful, concise information. Daily goal sheets are used to communicate essential information, enhance efficiency and increase consistency of care, thereby reducing complications and decreasing length of stay. “Daily goal sheets maintain a public record of thought processes and decision making by the multidisciplinary team.”1

When pondering how the aforementioned situation can be improved, it becomes apparent that implementing the multiprofessional team rounds and daily goal sheets will help to communicate the short- and long-term goals for the patient. “By stating clearly the tasks, care plan, and communication plan to be accomplished and ensuring that all members of the care team understood these tasks” can reduce complications and patient length of stay.2

The next time you enter the unit and the beds are full, the environment is noisy and confusing, and you need to triage, consider the options for ensuring quick, concise and thorough communication with your team. Remember, effective communication requires a sender, receiver, and most importantly, a clear message. To guarantee accuracy, efficiency and safety we must slow down and participate in active listening, make certain we understand the information fully and are not making “assumptions,” and finally, be willing to repeat the message if there is any potential for misunderstanding. This is often difficult given the patient load and time constraints that we all face in healthcare today. However, one misunderstood message often leads to a need to contact the physician for clarification, which is time consuming for both the nurse and the physician.

Creating tools like the daily goal sheets, discussing the patient’s care in a multiprofessional team setting, and outlining the objectives of the day will generate an efficient and streamlined approach to your work. Due to the sheer volume and complexity of information being shared in the ICU, a tool is needed to focus all data and recommendations coming from various sources, thus producing a reliable action plan. By creating a consistent flow of communication we will be able to provide high quality care with attention to details and patient safety.