The Society of Critical Care Medicine at 50 Years: Interprofessional Practice in Critical Care: Looking Back and Forging Ahead

Abstract

Interprofessional practice in the ICU has been embraced as a standard of care since the early origins of the Society of Critical Care Medicine (SCCM) (1, 2). This focus has been instrumental in improving the care and outcomes of patients with life-threatening illness and injuries utilizing teams of critical care professionals (2). The ICU team is typically comprised of physicians, bedside nurses, nurse practitioners (NPs), physician assistants, clinical pharmacists, respiratory therapists (RTs), dieticians, physical/occupational therapists, case management and social work, dietician/nutritionists, spiritual support, as well as clinicians-in-training, among others. In the interprofessional team model, members of the ICU team communicate, collaborate, consult, and capitalize on the individual expertise of each team member (3). As highlighted by Dr. Max Harry Weil, the first president of SCCM, the ICU team is committed to bringing orderliness and expertise to the management of the critically ill patient (2). The coronavirus disease 2019 (COVID-19) pandemic and news reports of patients in the ICU during the pandemic served to raise the awareness of the general public of ICU care. More than ever, the importance of team-led care in the ICU became evident during the ongoing pandemic. In this article, part of a series on the 50th anniversary of SCCM in Critical Care Medicine, we review key aspects of interprofessional practice in critical care.Efforts to advance interprofessional team-based care in the ICU are essential for improving patient outcomes and ICU team performance (4). Evidencebased best practice for effective interprofessional team care has identified the importance of multidisciplinary rounds that include ICU patients and family members in the care discussions and decision-making, and uses communication strategies that foster inclusive and supportive behaviors to enhance interprofessional collaboration in the ICU (5). A review by the American College of Critical Care Medicine (ACCM) Task Force on Models of Critical Care highlighted the importance of multidisciplinary ICU rounds in reducing mortality independent of the care team structure (1). Additionally, optimal interprofessional team performance also appears contingent upon open communication, conflict resolution, cooperation, coordination, and coaching between individual team members (Table 1) (6). The frequent changing of individual ICU team members due to rotations and different schedules from day to day has been identified as a potential challenge in ICU team performance (7, 8). However, ICU professionals function cohesively as a team, sharing their

Dietitians’ Role in Critical Care Interdisciplinary Team Needs Better Recognition

“…The dietitian is the most knowledgeable member of the interprofessional healthcare team with respect to identification of malnutrition, macro- and micronutrient requirements, and the type of nutrition support therapy indicated, and a growing number of dietitians are placing small bowel feeding tubes to facilitate early enteral feeding. Further, none of the four authors in the publication by Kleinpell et al (1) are dietitians/nutritionists.…”

“…Whether it is by direct or virtual evaluation, it is impossible to provide optimal care to critically ill patients without the participation of dietitians. This concept is given importance in the most recent and past critical care guidelines (3), in which the lead authors and several coauthors are dietitians, yet not given the much-needed recognition in your recent publication (1).…”

“…To the Editor: A recent publication in Critical Care Medicine by Kleinpell et al (1) outlines the importance of interprofessional practice but has made one significant oversight. Although the dietitian/nutritionist is briefly acknowledged in the Overview section of the article as a member of the critical care team, there is no further mention throughout.…”

“…To the Editor: I am writing regarding the article in Critical Care Medicine by Kleinpell et al (1). Registered dietitian nutritionists (RDNs) value interprofessional collaboration; however, the article lacks a recognition of our crucial role and expertise on the critical care interdisciplinary team, specifically with inclusion in Table 2 in (1).…”

Right Care, Right Now: Bringing More Critical Care to Boarding Patients in the Emergency Department*

“…The Society of Critical Care Medicine describes a multidisciplinary intensivist-led team with critical care nurses, pharmacists, respiratory therapists, registered dieticians, advance practice providers, physical/occupational therapists, patient care assistants, and others dedicated to the care of the critically ill. Critical care is a 24/7 enterprise with continuous monitoring and intervention. It incorporates team-based communication, patient-centered plans, and time at the bedside to delineate care (5). Critical care provides infrastructure to respond to the evolution of disease, using diagnostics, measuring response to interventions, and providing evidence-based care (3).…”