Acute respiratory failure requiring mechanical ventilation affects over 750,000 patients each year. Mortality in this group is high, ranging from 30 to 40%. Recent data suggest that interprofessional care practices, such as the Awakening, Breathing, Coordination, Delirium and Early Mobility/Exercise bundle (ABCDE) can improve patients' outcomes, specifically length of mechanical ventilation and ventilator associated-events. Yet these practices are inconsistently applied. One of the main barriers to ABCDE delivery is interprofessional teamwork. Interprofessional teamwork is defined as having multiple different professionals working together to deliver care. In this way, ABCDE serves a model system to examine interprofessional teamwork - focusing on who is part of the team (structure) and how the team works together (function). The overall goal of this project is to understand how ICU interprofessional team structure and function influence high quality care. By understanding who is part of the ICU interprofessional team and how the team works together for complex care delivery, interventions can be better targeted to the influential team of clinicians to improve complex care delivery, provider safer patient care. We take a novel approach to examine interprofessional team structure using network analysis combined with qualitative methods to examine interprofessional team function in 2 ICUs with high ABCDE delivery and 2 ICUs with lower ABCDE delivery. Our study has 3 Specific Aims: 1) measure the variability of interprofessional team structure for mechanically ventilated patients using network analysis; 2) describe how the ICU interprofessional team functions within the context of ABCDE delivery and 3) examine the relationship between ICU interprofessional team structure, ABCDE and duration of mechanical ventilation and ventilator-associated events. Completion of these Aims will advance our knowledge of the relationships between ICU interprofessional team structure and function and how it influences quality care - leading to actionable targets to improve interprofessional teamwork and complex care delivery. This will also provide a platform for the career development of the primary investigator, Deena Kelly Costa PhD, RN. This project builds on Dr. Costa's past training in quantitative methods, including network analysis but extends it in 2 essential areas: (1) qualitative methods; (2) theories of organizational change and implementation science. The research project, highly experienced multidisciplinary mentorship team and unparalleled research environment are ideally suited to address the career goals and educational needs of Dr. Costa. This career development award lays the groundwork for Dr. Deena Kelly Costa to perform ongoing innovative health services research and to become an independent investigator and national leader in ICU interprofessional teamwork research; to ultimately improve ICU interprofessional teamwork and implementation of complex care delivery, leading to improved survival and outcomes in this high-risk patient group.

Public Health Relevance

This project will assess how ICU interprofessional teamwork influences care and outcomes for mechanically ventilated patients. This work will identify characteristics of ICU teams that enable high quality care, providing crucial information to improve ICU care, reduce time spent on a ventilator and minimize poor outcomes for mechanically ventilated patients. The results will have direct impact in informing interventions to improve ICU interprofessional teamwork and improving care and outcomes of mechanically ventilated patients in Michigan and ultimately, elsewhere.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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Healthcare Research Training (HCRT)
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Willis, Tamara
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University of Michigan Ann Arbor
Schools of Nursing
Ann Arbor
United States
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Costa, Deena Kelly; Moss, Marc (2018) The Cost of Caring: Emotion, Burnout, and Psychological Distress in Critical Care Clinicians. Ann Am Thorac Soc 15:787-790
Prescott, Hallie C; Costa, Deena Kelly (2018) Improving Long-Term Outcomes After Sepsis. Crit Care Clin 34:175-188
Costa, Deena Kelly; Valley, Thomas S; Miller, Melissa A et al. (2018) ICU team composition and its association with ABCDE implementation in a quality collaborative. J Crit Care 44:1-6
Boltey, Emily; Yakusheva, Olga; Costa, Deena Kelly (2017) 5 Nursing strategies to prevent ventilator-associated pneumonia. Am Nurse Today 12:42-43
Costa, Deena Kelly; White, Matthew R; Ginier, Emily et al. (2017) Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review. Chest 152:304-311
Costa, Deena Kelly; Dammeyer, Jennifer; White, Matthew et al. (2016) Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool. BMC Res Notes 9:408