Enhancing Interdisciplinary Communication and Collaboration in the Management of Adult ECMO Patients: A Quality Improvement Project

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) provides temporary life support to patients with severe cardiogenic shock or refractory respiratory failure. Over the last decade, ECMO patient volume has only continued to rise especially following findings of the landmark CESAR trial wherein ECMO appeared superior to conventional ventilator support for adults with severe respiratory failure. Due to the rising volume of ECMO cases as well as the complex interaction of patient and circuit-related factors, care of the adult ECMO patient requires a skilled multidisciplinary team approach—effective communication and collaboration at the core of high-quality care. Objective: The purpose of this DNP project was to improve interprofessional communication and collaboration in the care of adult ECMO patients through implementation the ECMO Daily Goals Tool. Perceived changes in knowledge of the ECMO plan of care was assessed as a secondary outcome. Design: This quality improvement project utilized a pre- and post-implementation survey design. Setting: The 30-bed intensive care unit (ICU) at Mayo Clinic Hospital, a 268-bed academic tertiary care hospital in Phoenix, Arizona. Participants: Participants included core ECMO team members including cardiothoracic surgeons, intensivists, critical care advanced practice providers, cardiothoracic surgery advanced providers, perfusionists, and registered nurse (RN) ECMO specialists (RNES). A total of 62 ECMO team members were eligible to participate in the pre-implementation survey. Due to the unpredictability and variable volume of ECMO patients at any given time, individual ECMO staff who receive the post-implementation survey were automatically selected based on their direct involvement in an ECMO patient’s care. A total of 42 ECMO team members were eligible to participate in the post-survey. Measurements: Pre- and post-implementation surveys included one multiple choice question that sought to determine the distribution of participants’ roles within the ECMO team and fourteen Likert items categorized to assess the current state and any perceived improvements in communication, collaboration, and knowledge of the plan of care. The last question was unique to the post-survey and was an opportunity for participants to make comments and suggestions for improvement. Descriptive statistics (i.e., mean & standard deviation) were used to compare and analyze each Likert item. Results: Overall, this quality improvement project achieved its objectives and ultimately found that the implementation of the ECMO Daily Goals Tool led to an improvement in collaboration and the development and communication of ECMO-related goals, a more consistent and comprehensive approach to goal planning, a structured and individualized approach to goal creation, an improved knowledge of the plan of care. Conclusion: Due to the complexities inherent to care of the ECMO patient, there is an increased risk and impact of medical errors that can result from team communication and collaboration deficiencies that lead to failures in team decision making. Effective communication and collaboration between healthcare providers, therefore, is essential to delivering high quality collaborative care. Based results of this project, use of the ECMO Daily Goals Tool can improve communication, collaboration, and knowledge of the plan of care.