Intensive Care Unit Collaboration and Workflow in the Information Age

Abstract

The intensive care unit (ICU) is a complex amalgam of physical and cognitive workflows of its various personnel. The ICU team is compiled of persons with widely varying scopes of practice, levels of experience, roles, and responsibilities. Basic categories of personnel include bedside nurse, charge nurse, resident, advanced practice provider, pharmacist, nutritionist, fellow, attending, and consultant. Together, team members must collaborate to learn about and stabilize the critically ill patient, diagnose clinical states, plan and execute treatment, and monitor illness and recovery. The disparate geography and workflow of each individual guarantees that communication between team members will be complex. Issues of collaboration, teamwork, communication, and workflow are therefore paramount.

Team members may interact with the same technology with fundamentally different purposes, aligned with their scope of practice. The study of distributed cognition and how it affects interaction with health information technology (HIT) can better inform standards of its development. In every local ICU and hospital environment, the transmission of information is accomplished in unique combinations of verbal, paper, and electronic methods. When alterations occur in these highly evolved communication ecosystems (such as the introduction of new members or implementation of new electronic systems), the sturdiness of its homeostasis is tested, and patient safety can be put at risk.