Table 2.

ICU Interdisciplinary collaboration coding framework and Ssupporting quotations: core process of working together [18, 19]

Team	(+) Resident: [During rounds] a resident can easily enter orders on the wrong patient or confuse orders because they are catching up on previous patients…there are some good pharmacy checks and there are good nursing checks, [that] is the way…that orders are done correctly.
	(-) Nurse: There are so many clinicians involved in patient care at a teaching hospital that it can be challenging for one to recall who he or she spoke to about an issue, information or a request.
Patient focus	(+) Nurse: In a subspecialty unit like ours, there are certain standards that we all know and follow.
	(-) Resident: It’s not that it’s not patient-focused, but it’s just everybody is very collegial a lot of times. I think there’s a lot of unspoken, like this is what we’re doing. We’re giving a little albumin; we’re waking them up. And sometimes it’s said, sometimes it’s just implied.
Coordination	(+) Resident: For some tasks the resident has to do some things and the nurse will wait…and then like when the nurse is admitting the patient…after the resident can figure some stuff out.
	(-) Nurse: Things are delayed for any patient, stable or unstable because of rounds…[the residents will say] “well, we’re going to put an order in for that, but we’re not putting it until after rounds are over.”
Sharing	(+) Resident: [During rounds] the resident presents what he or she heard happen overnight and how the issues were dealt with. And the nurse will mention, “well this is what I got in my sign-out.” It is usually in agreement with minor variations of what the numbers are.
	(-) Resident: Someone will say, “Oh, this patient is on Lasix,”…and another will say, “No, we stopped that days ago.” And it’s funny how you can’t agree on something as simple as a medication.
Verbal Information Exchange1	(+) Resident: It’s a lot faster and easier to ask ‘Please, just verbally, quickly tell me what’s going on.’
	(-) Nurse: It doesn’t all get written down [at rounds] and the night nurses don’t know, sometimes in the report it gets lost in transition…miscommunication or doesn’t get passed on, and you work twelve hours with one eye closed, basically not having all the information with you.
	(-) Resident: A third of the time, usually the event is communicated verbally and the issues or treatment and results are communicated verbally again, but nothing’s ever written down.
Documentation Information Exchange1	(+) Resident: The [beside chart] of the nurse’s notes…past medical history and pertinent… a log of what happened. If I know a specific event happened, and I’m trying to get more details, that’s where I may go.
	(+) Nurse: Writing things down in succinct manner physically next to the patient is very helpful. Because [then] everyone’s very aware of it and people start saying, “Hey, did you see them?” “No, let’s call them again.” It’s very helpful in getting things done and communicating, because it’s written down, kind of almost set in stone once something’s written down.
	(-) Nurse: The computer system doesn’t even remotely match what’s going on with the patient. It’s ridiculous; there’ll be Cardizem hanging [intravenous medication] and no orders for it [in CPOE system].

¹Category added; (+) positive aspect of category, (-) negative aspect of category