ICU Multidisciplinary Team

As described in the previous section, successful ICU care depends on the efforts of many different types of ICU caregivers and support staff. Such teams address the complexity of today's ICU and encompass the many disciplines that must coordinate their care to provide efficient, effective and safe care. This section continues the discussion of ICU infrastructure by describing the constituency of ICU Multidisciplinary Teams. 20

Team Leadership

Every hospital with an ICU should have a physician-led multidisciplinary team that guides and evaluates the performance of the ICU. The multidisciplinary team should be led by an intensivist or other appropriately qualified physician as defined by the MH&SC. For hospitals where these physicians are not available, the team should be led by an FCCS-certified, hospital-based physician. As previously mentioned, having a hospitalist does not meet the MH&SC guideline but is considered an interim measure toward meeting the guideline.

Team Constituency

Although the composition of multidisciplinary teams will vary based on patient characteristics and local needs, a team could include the following types of staff:

• An APACHE coordinator. APACHE, Acute Physiology and Chronic Health
• Evaluation System, is used to evaluate patient severity using statistical methods.
• Critical care nurse
• Dietician
• ICU nurse manager
• Intensivist or other appropriately qualified physician as defined by the MH&SC.
• For hospitals where these physicians are not available, the team should be led by an FCCS-certified, hospital-based physician. 21
• Occupational therapist
• Palliative care representative
• Pastoral care representative
• Patient or family representative
• Pharmacist
• Physical therapist
• Psychologist
• Respiratory therapist
• Social worker
• Other attending physicians including surgeons where applicable

Implementing Multidisciplinary Teams

The intensivist or the medical director of the ICU when an intensivist is not available should lead an effort that includes the nurse manager, appropriate administrative executive staff and leadership from each of the disciplines to develop a plan for establishing and deploying a multidisciplinary team. The plan should address the constituency of the ICU’s multidisciplinary team, establish team roles and responsibilities, and a strategy for obtaining administrative approval for instituting multidisciplinary team-based care in the ICU.

The plan should identify all members of the team. The plan should also identify the roles and responsibilities of team members. Team responsibilities include:

1. establishing ICU operational procedures;
2. participating in individual patient management decisions during multidisciplinary patient rounds;
3. evaluating and setting practice standards for the ICUs;
4. establishing a culture of patient safety within the ICU;
5. planning and implementing patient safety improvement activities; and
6. measuring the effects of safety improvement activities.

In particular, the effects that should be monitored include assessing team effectiveness as it relates to the safety, efficiency and effectiveness of ICU care; disease and surgery-specific patient outcomes; and organizational outcomes. At least one member of the multidisciplinary team should be assigned to monitor the safety reporting literature to look for safety improvement opportunities to be incorporated into ICU practices as appropriate.

Lastly, the plan should also make explicit a strategy for obtaining administrative leadership approval for the multidisciplinary team and its related ICU responsibilities. Once the plan is developed, ICU leadership should obtain approval for the plan and implement it.

20 Brilli RJ, Spevetz A, Branson RD, et al. (2001). Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model. Crit Care Med. 29(10):2007-2019.

21 Note: Having an appropriately qualified physician or FCCS-certified physician does not meet MH&SC guidelines but is considered an interim measure toward meeting the guideline.

© 2004 Michigan Health and Safety Coalition