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Teamwork – It’s a Matter of Life and Death

May 30, 2023

Written by Rebecca White

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There was an increased number of patient deaths on ICU shifts with low nurse-to-nurse familiarity.

Why does this matter?
Familiarity within the medical team has shown many benefits, including improved communication, teamwork and performance in medical simulations. Is it possible that patient outcomes are affected by how well the nursing team knows one another?

Nice to see a familiar face…
This multicenter, retrospective observational study included data from eight adult academic ICUs in France from January 2011 to December 2016. Nurse-to-nurse familiarity was quantified as the mean number of prior shifts individual nurses worked together; high-familiarity was considered at least 50 previous collaborations. The study considered a lagged effect of nurse familiarity by determining if a lower familiarity one or two shifts prior impacted death rate.

A total of 43,479 ICU patients (65% men) were included, with length of stay 6 ± 12 days and mortality rate of 15% (n = 6,306). Patients for whom a decision to forgo life-sustaining therapy (DFLST) was made were excluded from the study, leaving 3,311 remaining (8%). There were 3,101 shifts during which at least one death without DFLST occurred (9%). There was a lower risk of mortality when nurse-to-nurse familiarity increased during a shift (RR 0.90; 95% CI 0.82-0.98; P = 0.012, by increase of 10 shifts), one shift before (RR, 0.96; 95% CI 0.93-0.98; P = 0.001), and two shifts before (RR 0.96); 95% CI 0.93-0.99; P = 0.022). Nurse-to-nurse familiarity and patient death within 12-hours of ICU admission did not show a statistically significant relationship.

Nurse-to-Nurse Familiarity and Mortality in the Critically Ill: A Multicenter Observational Study. Am J Respir Crit Care Med. 2023 Apr 15;207(8):1022-1029. doi: 10.1164/rccm.202204-0696OC.

Editor’s note: We all know the adage – ‘Teamwork makes the dream work‘ – but it appears that our ability to form effective healthcare teams is not just dream fulfillment – it’s a matter of life and death. ~Clay Smith

What are your thoughts?