It takes teamwork: Consideration of difficult hospital-acquired conditions

In the intensive care unit (ICU), teams manage the most vulnerable patients in a complex, high-risk, fast-paced environment. These patients are cared for in heavily monitored environments, creating a large interface between providers and technology, increasing the cognitive burden of the care team. Challenges inherent to these environments include coordination of multiple providers in complementary roles, establishment of and adherence to protocols and processes that optimize system function and enhance patient safety, and monitoring and management of copious data streams. Despite intended enhancements to patient safety, the complexity of the care system may, in fact, increase opportunities for harm, and because of the fragility of the patient population, patients are less likely to tolerate lapses in care and are at greater risk when harm does occur. Tackling problems in these environments requires invested interprofessional teams, effective data collection and monitoring-both for identifying safety problems and for measuring the impact of efforts to address them-and a culture that continuously seeks to identify problems and design creative, streamlined solutions. Successful and sustainable efforts in this multidisciplinary environment require active engagement by multiple stakeholders from the outset and continued investment to generate sustainable gains. Unintended extubation, the unintentional dislodgement, or loss of an endotracheal tube in a mechanically ventilated patient is an event unique to the ICU environment and is associated with significant patient harm. We will explore the interdisciplinary approach to safety problems in the ICU that is required to assure sustainable gains.