Impact of Multidisciplinary Teamwork on Patient Outcomes in Respiratory Emergencies: A Narrative Review
DOI:
https://doi.org/10.29070/b47yfx97Keywords:
multidisciplinary teamwork, interprofessional collaboration, respiratory failure, critical care, patient outcomes, rapid response teams, mechanical ventilation, crisis resource management, patient safetyAbstract
Background. Respiratory emergencies — acute exacerbations of chronic obstructive pulmonary disease (COPD), status asthmaticus, severe community-acquired pneumonia, acute respiratory distress syndrome (ARDS), high-risk pulmonary embolism and acute hypoxaemic or hypercapnic respiratory failure — are among the most time-critical presentations in acute care. Their management is inherently distributed across physicians, nurses, respiratory therapists, pharmacists, physiotherapists and allied staff. Whether the quality of the collaboration between these disciplines independently influences patient outcomes, over and above the individual interventions delivered, has become a central question in critical care quality improvement.
Objective. To synthesise the conceptual, empirical and implementation literature on multidisciplinary and interprofessional teamwork in respiratory emergencies, to identify the mechanisms through which teamwork is translated into measurable patient benefit, and to define the methodological limits of the current evidence base.
Methods. A narrative review informed by a structured search of MEDLINE/PubMed, CINAHL, Embase, the Cochrane Library and Scopus for literature published between January 1995 and December 2024, combining team-related and respiratory-emergency-related terms. Landmark trials, systematic reviews, meta-analyses, professional society guidelines and observational cohorts were prioritised; reference lists were hand-searched.
Findings. Convergent evidence from several distinct team models — rapid response and medical emergency teams, protocolised ventilator liberation led by nurses and respiratory therapists, structured difficult-airway teams, pulmonary embolism response teams (PERT), extracorporeal membrane oxygenation (ECMO) programmes and interprofessional ICU rounding — associates organised multidisciplinary working with reduced mortality, shorter duration of mechanical ventilation, shorter intensive care and hospital length of stay, higher first-pass intubation success, fewer peri-intubation complications, better guideline and bundle adherence, and improved family experience. Effect sizes are heterogeneous and are strongly conditioned by implementation fidelity, baseline organisational performance and case mix. The causal pathway appears to run through shared mental models, closed-loop communication, explicit role allocation, psychological safety, distributed cognitive load and structured information transfer rather than through team composition alone.
Conclusions. Multidisciplinary teamwork is best understood not as an adjunct to clinical care in respiratory emergencies but as a determinant of whether evidence-based interventions are delivered reliably, completely and in time. The principal research gaps are the scarcity of adequately powered cluster-randomised designs, the absence of a standardised core outcome set linking team process measures to patient endpoints, and the near-total under-representation of low- and middle-income settings.
Downloads
References
1. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
2. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13(Suppl 1):i85–i90.
3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2024 Report.
4. Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units. JAMA. 2020;323(15):1478–1487.
5. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries (LUNG SAFE). JAMA. 2016;315(8):788–800.
6. Ferguson ND, Fan E, Camporota L, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573–1582.
7. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–1308.
8. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome (PROSEVA). N Engl J Med. 2013;368(23):2159–2168.
9. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817–822.
10. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000;355(9219):1931–1935.
11. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335(25):1864–1869.
12. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543–603.
13. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2024 Update.
14. Salas E, Sims DE, Burke CS. Is there a "Big Five" in teamwork? Small Group Res. 2005;36(5):555–599.
15. King HB, Battles J, Baker DP, et al. TeamSTEPPS: team strategies and tools to enhance performance and patient safety. In: Advances in Patient Safety: New Directions and Alternative Approaches. Rockville, MD: AHRQ; 2008.
16. Gaba DM, Fish KJ, Howard SK, Burden A. Crisis Management in Anesthesiology. 2nd ed. Philadelphia: Elsevier; 2015.
17. Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–383.
18. Nembhard IM, Edmondson AC. Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav. 2006;27(7):941–966.
19. Hutchins E. Cognition in the Wild. Cambridge, MA: MIT Press; 1995.
20. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377.
21. Levy MM, Rhodes A, Phillips GS, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med. 2014;40(11):1623–1633.
22. Fan E, Del Sorbo L, Goligher EC, et al. An official ATS/ESICM/SCCM clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–1263.
23. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–1116.
24. Kabrhel C, Rosovsky R, Channick R, et al. A multidisciplinary pulmonary embolism response team: initial 30-month experience with a novel approach to delivery of care to patients with submassive and massive pulmonary embolism. Chest. 2016;150(2):384–393.
25. Barbaro RP, Odetola FO, Kidwell KM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Am J Respir Crit Care Med. 2015;191(8):894–901.
26. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR). Lancet. 2009;374(9698):1351–1363.
27. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome (EOLIA). N Engl J Med. 2018;378(21):1965–1975.
28. Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–2097.
29. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18–26.
30. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care. 2015;19:254.
31. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465–470.
32. Churpek MM, Yuen TC, Winslow C, et al. Multicenter development and validation of a risk stratification tool for ward patients. Am J Respir Crit Care Med. 2014;190(6):649–655.
33. Escobar GJ, Liu VX, Schuler A, et al. Automated identification of adults at risk for in-hospital clinical deterioration. N Engl J Med. 2020;383(20):1951–1960.
34. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–631.
35. Jaber S, Jung B, Corne P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36(2):248–255.
36. Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120(2):323–352.
37. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–848.
38. Chrimes N. The Vortex: a universal 'high-acuity implementation tool' for emergency airway management. Br J Anaesth. 2016;117(Suppl 1):i20–i27.
39. Kollef MH, Shapiro SD, Silver P, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25(4):567–574.
40. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial). Lancet. 2008;371(9607):126–134.
41. Blackwood B, Alderdice F, Burns K, et al. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237.
42. Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med. 2014;42(5):1024–1036.
43. Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU Liberation Collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3–14.
44. Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18(2):71–75.
45. Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71–77.
46. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369–376.
47. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288(17):2151–2162.
48. Wilcox ME, Chong CA, Niven DJ, et al. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med. 2013;41(10):2253–2274.
49. Kerlin MP, Small DS, Cooney E, et al. A randomized trial of nighttime physician staffing in an intensive care unit. N Engl J Med. 2013;368(23):2201–2209.
50. Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019;3(3):315–330.
51. Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019;7(2):163–172.
52. Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program (I-PASS). N Engl J Med. 2014;371(19):1803–1812.
53. Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf. 2006;32(3):167–175.
54. Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(21):2175–2183.
55. Wilcox ME, Adhikari NKJ. The effect of telemedicine in critically ill patients: systematic review and meta-analysis. Crit Care. 2012;16(4):R127.
56. Hughes AM, Gregory ME, Joseph DL, et al. Saving lives: a meta-analysis of team training in healthcare. J Appl Psychol. 2016;101(9):1266–1304.
57. Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45(1):103–128.
58. Curtis JR, Treece PD, Nielsen EL, et al. Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med. 2016;193(2):154–162.
59. Poncet MC, Toullic P, Papazian L, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007;175(7):698–704.
60. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. An official critical care societies collaborative statement: burnout syndrome in critical care healthcare professionals. Crit Care Med. 2016;44(7):1414–1421.
61. Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol. 2015;5:1573.
62. Hunziker S, Johansson AC, Tschan F, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011;57(24):2381–2388.
63. Marsch SC, Müller C, Marquardt K, Conrad G, Tschan F, Hunziker PR. Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation. 2004;60(1):51–56.
64. Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 2014;90(1061):149–154.
65. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–1993.
66. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824–1830.
67. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2013;(3):CD002213.
68. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;(3):CD000072.
69. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA. 2011;306(9):978–988.
70. Boet S, Bould MD, Fung L, et al. Transfer of learning and patient outcome in simulated crisis resource management: a systematic review. Can J Anaesth. 2014;61(6):571–582.
71. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–1700.
72. Cooper S, Cant R, Porter J, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation. 2010;81(4):446–452.
73. Walker S, Brett S, McKay A, Lambden S, Vincent C, Sevdalis N. Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR): development and validation. Resuscitation. 2011;82(7):835–844.
74. Adhikari NKJ, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339–1346.
75. Murthy S, Leligdowicz A, Adhikari NKJ. Intensive care unit capacity in low-income countries: a systematic review. PLoS One. 2015;10(1):e0116949.
76. Andrews B, Semler MW, Muchemwa L, et al. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA. 2017;318(13):1233–1240.
77. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574–1581.
78. RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693–704.
79. Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433–450.
80. Dietz AS, Pronovost PJ, Mendez-Tellez PA, et al. A systematic review of teamwork in the intensive care unit: what do we know about teamwork, team tasks, and improvement strategies? J Crit Care. 2014;29(6):908–914.
81. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53(2):143–151.
82. Reader TW, Flin R, Mearns K, Cuthbertson BH. Developing a team performance framework for the intensive care unit. Crit Care Med. 2009;37(5):1787–1793.
83. Donovan AL, Aldrich JM, Gross AK, et al. Interprofessional care and teamwork in the ICU. Crit Care Med. 2018;46(6):980–990.
84. Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open. 2019;9(9):e028280.
85. Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum Resour Health. 2020;18:2.
This work is licensed under a 