Name of the Game is Teamwork ICU Kent Hospital

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Name of the Game is Teamwork ICU- Kent Hospital

• By
• Ehsun Mirza, MD
• Virginia Wilcox, RN

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ICU at Kent Hospital

• 15 bed medical surgical ICU.
• Annual admissions are 950-1000
• Full spectrum of medical and surgical cases
  (except CT surgery).
• Total number of Staff (non Doctor/PA) 55
• Nurses (50)
• Respiratory therapists
• Pharmacist
• Dietitians
• Physical Therapists

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Rounding Team Structure in ICU(Weekdays)

• ICU attending physicians, PA since July 2008,
  Residents and medical students.
• Charge nurse, ICU nurses and graduate nurses.
• Respiratory Therapist.
• Pharmacist and Pharmacy Student.
• Clinical Dietitian.
• Others
• Speech
• PT/OT

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SAQ ResultsTeamwork climate domain score
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It is easy for personnel here to ask questions
when there is something that they do not
understand
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The Physicians and Nurses here work together as
a well coordinated team
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Cause For Concern

• ICU had always taken pride in having a very close
  working relationship with all its team members.
• Needed to immediately identify source of
  discontentment.
• Needed to ensure that the Team Leaders were doing
  what they were supposed to do in setting up the
  correct direction and good morale of the entire
  team.
• Tough questions needed to be asked of EVERYONE in
  the leadership position.

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ICU Survey administered to team members post-SAQ
results

• Needed to be all inclusive i.e all attending
  physicians, Physician Assistants and covering
  physicians of all shifts.
• Needed to be anonymous.
• Needed to ask tough and basic questions worthy of
  respect from the people who were going to fill
  them out.
• All non-attending personal who worked regularly
  in the ICU were to respond

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The Questions

• Team Player
• Efficient Rounding
• Respects Opinions
• Appropriateness of Response
• Procedural Skills
• Medical Management
• Family Discussions
• Availability
• Professional Demeanor
• Organizational Skills in ICU
• Progressive Attitude

• Do you like working with this person?
• Would you like this person to take care of your
  loved one?

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Sample
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Any Questions??
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Guidelines for Engagement

• By
• Ehsun Mirza, MD
• Virginia Wilcox, RN

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The Basics

• The patient is the center of our universe
• Everyone is a colleague
• All opinions are valid
• No question is stupid
• Always do good
• Do no harm
• Learning is promoted

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The Essentials

• Physician Champion
• Nurse Leader
• Visibility Ability to Listen
• Engaging the team in protocol development
• Including the team in problem solving
• Enlisting the help of the team to roll out and
  help educate their peers

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The Barriers

• Change in champions
• Size of rounding team
• Inconsistency with following protocols
• Prolonged rounds (beyond 2-hours)
• Patient rounds combined with teaching rounds

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What works best for us

• Protocol development by Workgroups
• Frequently asking team members How things are
  going
• Ensuring that issues are brought to the table
• Scheduling quarterly meetings with representation
  from each discipline

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My Philosophy

• Our patients always come first
• The staff and team members are a very close
  second
• The best ideas come from the front line
  caregivers
• The passion of our team never ceases to amaze me!
  It is one of the things that keeps me coming back
  every day.