**8. Team dynamics**

The relevance of team training is evident in the critical care setting. On any given day, various disciplines and providers from different professions interact to provide the best care to critically ill patients. This fluid interaction is significantly highlighted during acute clinical situations where dynamic changes in personnel occur frequently. The Joint Commission® lists communication error among the most common causality related to sentinel events [140]. Several barriers can compromise effective communication within the medical system, including behavioral, cognitive, linguistic, environmental, and technological sources. Identifying and analyzing communication obstacles can allow for implementation of specific evidence-based solutions [134, 141].

Failures in communication and teamwork are contributors to many adverse events. For the past 10 years, emphasis has been given to team training and multiple strategies have been described [142]. Desirable teamwork behaviors include situational monitoring, communication, leadership, mutual respect, trust, role participation, and shared mental models [143]. Effective response in interdisciplinary and interprofessional collaboration is enhanced during team training. Several training programs have been created including crew resource management (CRM), which originated from the aviation industry, medical team training (MTT) at the Veteran's Health Hospitals, and the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) from the AHRQ. A 2020 systematic review supported the effectiveness of team training in knowledge, skills, and attitudes (KSAs) after 30 days of training [144]. This systematic review collectively described improved patient outcomes, enhanced communication, and handoff tool implementation. It has been recommended to include team-training concepts throughout the career development of all healthcare professionals [142].

#### **8.1 Interprofessional collaboration**

To optimize the patient's journey in the ICU, genuine integration of multidisciplinary coordination must be the new norm. Given the fast-paced performance pressures applied to allied health personnel (pharmacists, RT, Nutrition support, OT, PT), their current roles will evolve to participant-consultant experts for the entire unit [54].

*Patient Safety in the Critical Care Setting: Common Risks and Review of Evidence-Based… DOI: http://dx.doi.org/10.5772/intechopen.108005*

Teaming on the fly is progressively common in critical care, especially when patients are experiencing hemodynamic instability and require emergent mechanical support. Extracorporeal membrane oxygenation can be used as a lifesaving strategy [145]. By default, this intervention requires a remarkably elevated level of interprofessional collaboration between perfusionists, respiratory therapists, physicians, physical therapists, and nurses, among many other roles.

#### **8.2 Collective intelligence**

The critical care environment is non-linear, complex, and characterized by stable and unstable equilibria. Operating as an adaptive system requires agility and a deep understanding of our interdependencies. As a result, we rely on each other's expertise to deliver the best and safest care during these critical moments of our patient's lives [146].

Every patient in the ICU is likely to benefit from the focused attention of multiple disciplines [54]. For this model to succeed, it will be essential to leverage synchronous and asynchronous communication technologies to elevate the collective intelligence. This construct is more critical than ever as we navigate diverse disciplines, engage experts from various backgrounds and generations, and integrate numerous technology-based solutions to augment the decision-making process. An example of this approach includes bedside rounds. In this activity, multiple disciplines organize daily to discuss the patient's condition, utilize various technologies such as the EMR and dashboards, and co-create the care plan.

Healthcare is moving away from the reductionist undertakings of individual performance to collective intelligence, improving the patient safety journey. We propose that there should be a deliberate institutional framework that maximizes collective intelligence, coordinating between quality improvement, patient safety, and risk management utilizing culture of safety principles to predict, prevent, and manage harm (**Figure 2**) [147].
