Skip to main content
SpringerLink
Log in

Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale

  • Original Article
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of leadership training on the quality of IDRs in the ICU.

Methods

A nonrandomized intervention study was conducted in four ICUs for adults. The intervention was a 1-day training session in a simulation environment and workplace-based feedback sessions. Measurement included 28 videotaped IDRs (total, 297 patient presentations) that were assessed with 10 essential quality indicators of the validated IDR Assessment Scale. Participants were 19 intensivists who previously had no formal training in leading IDRs. They were subdivided by cluster sampling into a control group (ten experienced intensivists) and intervention group (nine intensive care fellows). Mann–Whitney U test was used to compare results between control and intervention groups.

Results

Baseline measurements of control and intervention groups revealed two indicators that differed significantly. The frequency of yes ratings for the intervention group significantly increased for seven of the ten indicators from before to after intervention. The frequency of yes ratings after training was significantly greater in the intervention than control groups for eight of the ten essential quality indicators.

Conclusions

The leadership training improved the quality of the IDRs performed in the ICUs. This may improve quality and safety of patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, Kane-Gill SL, Kirchhoff KT, Levy M, Mitchell PH, Moreno R, Pronovost P, Puntillo K (2006) Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med 34:211–218

    Article  PubMed  Google Scholar 

  2. Ten Have EC, Tulleken JE (2013) Leadership training and quality improvement of interdisciplinary rounds in the intensive care units. Crit Care 17(Suppl 2):522. doi:10.1186/cc12460

    Google Scholar 

  3. Verma AA, Bohnen JD (2012) Bridging the leadership development gap: recommendations for medical education. Acad Med 87:549–550

    Article  PubMed  Google Scholar 

  4. Reader TW, Flin R, Mearns K, Cuthbertson BH (2009) Developing a team performance framework for the intensive care unit. Crit Care Med 37:1787–1793

    Article  PubMed  Google Scholar 

  5. Reader TW, Flin R, Cuthbertson BH (2011) Team leadership in the intensive care unit: the perspective of specialists. Crit Care Med 39:1683–1691

    Article  PubMed  Google Scholar 

  6. Stockwell DC, Slonim AD, Pollack MM (2007) Physician team management affects goal achievement in the intensive care unit. Pediatr Crit Care Med 8:540–545

    Article  PubMed  Google Scholar 

  7. Manser T (2009) Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 53:143–151

    Article  PubMed  CAS  Google Scholar 

  8. Malling B, Mortensen L, Bonderup T, Scherpbier A, Ringsted C (2009) Combining a leadership course and multi-source feedback has no effect on leadership skills of leaders in postgraduate medical education. An intervention study with a control group. BMC Med Educ 9:72

    Article  PubMed  Google Scholar 

  9. Hunziker S, Bühlmann C, Tschan F, Balestra G, Legeret C, Schumacher C, Semmer NK, Hunziker P, Marsch S (2010) Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med 38:1086–1091

    Article  PubMed  Google Scholar 

  10. Swanwick T, McKimm J (2011) What is clinical leadership… and why is it important? Clin Teach 8:22–26

    Article  PubMed  Google Scholar 

  11. Hunziker S, Laschinger L, Portmann-Schwarz S, Semmer NK, Tschan F, Marsch S (2011) Perceived stress and team performance during a simulated resuscitation. Intensive Care Med 37:1473–1479

    Article  PubMed  Google Scholar 

  12. Streiff S, Tschan F, Hunziker S, Buehlmann C, Semmer NK, Hunziker P, Marsch S (2011) Leadership in medical emergencies depends on gender and personality. Simul Healthc 6:78–83

    Article  PubMed  Google Scholar 

  13. Ten Have EC, Hagedoorn M, Holman ND, Nap RE, Sanderman R, Tulleken JE (2013) Assessing the quality of interdisciplinary rounds in the intensive care unit. J Crit Care. doi:10.1016/j.jcrc.2012.12.007

    PubMed  Google Scholar 

  14. Ten Have ECM, Nap RE (2013) Mutual agreement between providers in intensive care medicine on patient care after interdisciplinary rounds. J Intensive Care Med. doi:10.1177/0885066613486596

    Google Scholar 

  15. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM (2010) The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med 22:369–376

    Google Scholar 

  16. Azoulay E, Timsit JF, Sprung CL et al (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180:853–860

    Article  PubMed  Google Scholar 

  17. Rhodes A, Moreno RP, Azoulay E et al (2012) Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 38:598–605

    Article  PubMed  CAS  Google Scholar 

  18. Reader T, Flin R, Lauche K, Cuthbertson BH (2006) Non-technical skills in the intensive care unit. Br J Anaesth 96:551–559

    Article  PubMed  CAS  Google Scholar 

  19. Ellrodt G, Glasener R, Cadorette B et al (2007) Multidisciplinary rounds (MDR): an implementation system for sustained improvement in the American Heart Association’s Get With The Guidelines program. Crit Pathw Cardiol 6:106–116

    Article  PubMed  Google Scholar 

  20. CoBaTrICE Collaboration (2011) International standards for programmes of training in intensive care medicine in Europe. Intensive Care Med 37:385–393

    Article  Google Scholar 

  21. CoBaTrICE Collaboration, Bion JF, Barrett H (2006) Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 32:1371–1383

    Article  PubMed  CAS  Google Scholar 

  22. Boyle DK, Kochinda C (2004) Enhancing collaborative communication of nurse and physician leadership in two intensive care units. J Nurs Adm 34:60–70

    Article  PubMed  Google Scholar 

  23. Have EC, Tulleken JE (2013) Assessing the quality of interdisciplinary rounds. Crit Care 17(Suppl 2):P521. doi:10.1186/cc12459

    Article  Google Scholar 

  24. Randolph JJ (2008) Online kappa calculator. http://justusrandolph.net/kappa. Accessed 1 Dec 2011

  25. Randolph JJ (2005) Free-marginal multirater kappa: an alternative to Fleiss’ fixed-marginal multirater kappa. Joensuu University Learning and Instruction Symposium 2005. ERIC Document Reproduction Service No. ED490661

  26. Hawthorne G, Richardson J, Osborne R (1999) The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 8:209–224

    Article  PubMed  CAS  Google Scholar 

  27. Hair JF, Tatham RL, Anderson R (2005) Multivariate data analysis. Prentice-Hall, New Jersey

    Google Scholar 

  28. van Mook WN, de Grave WS, Gorter SL, Muijtjens AM, Zwaveling JH, Schuwirth LW, van der Vleuten CP (2010) Fellows’ in intensive care medicine views on professionalism and how they learn it. Intensive Care Med 36:296–303

    Article  PubMed  Google Scholar 

  29. Veronesi MC, Gunderman RB (2012) Perspective: the potential of student organizations for developing leadership: one school’s experience. Acad Med 87:226–229

    Article  PubMed  Google Scholar 

  30. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 3:CD002213

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all ICU professionals who participated in the videotaped sessions. We thank H. Delwig, intensivist of the Critical Care Department, for development of the course scenarios and H.E.P. Bosveld for performing the statistical analysis.

Conflicts of interest

The authors have no commercial association or financial involvement that might pose a conflict of interest connected with this article.

Author information

Authors and Affiliations

  1. Directorate Medical Affairs, Quality and Safety University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    Elsbeth C. M. Ten Have & Raoul E. Nap

  2. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Jaap E. Tulleken

Authors
  1. Elsbeth C. M. Ten Have
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raoul E. Nap
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaap E. Tulleken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elsbeth C. M. Ten Have.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 66 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ten Have, E.C.M., Nap, R.E. & Tulleken, J.E. Quality improvement of interdisciplinary rounds by leadership training based on essential quality indicators of the Interdisciplinary Rounds Assessment Scale. Intensive Care Med 39, 1800–1807 (2013). https://doi.org/10.1007/s00134-013-3002-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-013-3002-0

Keywords

Search

Navigation