Researchers have established that in intensive care units (ICUs) where there is poor leadership and poor collaborative communication between nurses and physicians, as much as a two-fold increase in risk-adjusted mortality and length of stay exists.
Specific aims of this study are to: (1) pilot a collaboration building intervention with nursing and physician leaders in two ICUs; (2) assess the feasibility of conducting a collaboration building intervention in diverse ICUs; (3) explore the effects of the intervention on collaborative skills of ICU nursing and physician leaders; (4) investigate the short term effects (6 months post-intervention) of the collaborative building intervention on: a) the patient outcomes of risk-adjusted mortality, adjusted length of stay, readmission to the ICU, and family member needs, and b) the organization outcomes of perceived technical quality of care, perceived ability to meet family member needs, work group cohesion, job stress, job satisfaction, and intent to stay. The study is structured as a pretest-posttest repeated measures design that incorporates baseline data collection, then implementation of the Collaboration Intervention over 8 months. A 6 month application period follows the intervention. In addition, immediate post-intervention data and 6 months post-information data will be collected. The study will include two diverse ICUs, a burn ICU and a combined medical-surgical ICU. Nursing and physician leaders will be participants in the Collaboration Intervention which has as its goal the enhancement of collaborative relationships within ICU leadership. The intervention is based on established, commercially available systems for effecting change in leadership behavior and collaborative communication. Nurses and physicians in the ICUs who are not participating in the intervention will respond to questionnaires regarding organization processes and outcomes in order to evaluate the effectiveness of the intervention beyond those directly receiving the intervention. Patient outcome data of risk-adjusted mortality, adjusted length of stay, readmission to the ICU, and family needs also will be collected. Data analysis will include descriptive statistics, t-tests, and repeated measures analysis of variance. The proposed study is the first intervention-focused study on collaboration building among ICU nurse and physician leaders. This pilot study is designed to determine the feasibility and value of the proposed intervention, as well as to identify design issues requiring modification prior to a larger multisite clinical trial.
