Citations

Hematopoietic cell transplantation (HCT) is an important and complex treatment modality for a variety of hematologic malignancies and some solid tumors. Although outcomes of patients who have undergone HCT and require care in intensive care units (ICUs) have improved over time, mortality rates remain high and there are significant associated costs. Lack of a team-based approach to care, especially during critical illness, is detrimental to patient autonomy and satisfaction, and to team morale, ultimately leading to poor quality of care. In this manuscript, we describe the case of a patient who had undergone HCT and was in the ICU setting, where inconsistent team interaction among the various stakeholders delivering care resulted in a lack of shared goals and poor outcomes. Team cognition is cognitive processing at the team level through interactions among team members and is reflected in dynamic communication and coordination behaviors. Although the patient received multidisciplinary care as needed in a medically complicated case, a lack of team cognition and, particularly, inconsistent communication among the dynamic teams caring for the patient, led to mixed messages being delivered with high-cost implications for the health-care system and the family. This article highlights concepts and recommendations that begin a necessary in-depth assessment of implications for clinical care and initiate a research agenda that examines the effects of team cognition on HCT teams, and, more generally, critical care of the patient with cancer.

Background: The American Heart Association (AHA) estimates that annually there are approximately 200,000 in-hospital cardiac arrests (IHCA). Hospitals have implemented multidisciplinary teams trained in advanced cardiac life support (ACLS) to provide care during these events. Outcome measures of these team’s effectiveness are typically mortality rates at discharge and reduction of unplanned cardiac arrest occurring outside of the ICU. Neither is a sensitive measure of team effectiveness. Methods: Using a retrospective analysis of 10 simulated code blue events we developed a metric of team effectiveness for code blue teams that also identifies specific teamwork weaknesses. Results: The new ASU-Mayo metric was highly correlated with Mayo high performance team scale (MHPTS) (r (6) = .71), team emergency assessment measure (TEAM) (r (6) = .84), and the observational skill-based assessment tool for resuscitation (OSCAR) (r (6) = .89) metrics as well as the ratings of the subject matter experts (r (6) = .88). Conclusions: We developed a team performance metric that allows for the identification of performance gaps therefore, can allow for targeted intervention with the intention of providing trainees richer feedback on performance. Also, it will generate quantitative assessments of the value of mock code exercises and can be used to evaluate interventions. Our understanding of teamwork during a simulated code blue event was also enhanced.

Background: Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. Materials and Methods: Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. Results: During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. Conclusions: Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.