An Attending-Directed Intervention to Enhance Interprofessional Teaching on ICU Rounds.

Abstract

Introduction: Interprofessional teaching (IPT) during rounds may enhance teamwork and collaborative patient care, but previous studies have shown low rates of IPT during intensive care unit (ICU) rounds. We designed a study to explore contributions by interprofessional providers (IPPs) during ICU rounds and an attending-targeted intervention to promote IPT.

Methods: Using a novel observation tool, we collected details regarding contributions made by IPPs during rounds in two ICUs at an academic medical center. A study team member conducted observations for six weeks before and after implementation of an attending-directed intervention. Comparisons were made between pre- and post-intervention data.

Results: Before the intervention, six attendings were observed for 59 patient-rounds with 309 contributions recorded, and after, eleven attendings were observed for 94 patient-rounds with 512 contributions recorded. The majority of contributions from IPPs were classified as "reporting" (pre/post: 42.7% vs. 43.6%) and "observing" (pre/post: 29.1% vs. 29.7%). "Teaching" contributions were rare, but increased from 3.9% (12/309) to 4.7% (24/512) of all contributions (p > 0.05). The mean number of contributions per patient did not change after the intervention (5.24 vs. 5.45), and the types of contributions were similar across different attendings. When an IPP spontaneously provided a recommendation (pre: 33, post: 55), the contribution often changed the care plan (pre/post: 97.0% (32/33), 83.6% (46/55)).

Conclusions: IPPs predominantly contribute to rounds by reporting data and providing observations. An intervention to improve attending facilitation of IPT did not affect rates of teaching. However, recommendations made by IPPs consistently impacted the patient care plan.