A mixed methods study of backup behavior among interprofessional ICU teams

Background: Backup behavior—when clinicians help each other via verbal assistance or task completion in their roles–is essential for effective teamwork in the intensive care unit (ICU) but is not well understood. Exploring how interprofessional team members provide backup may guide future interventions. Objective: To examine who, how often, why, and under what circumstances ICU clinicians provide backup in mechanical ventilation care. Methods: Using a convergence, triangulation mixed methods design in 2 medical ICUs (2017–2019), we collected qualitative data (observation, shadowing, interviews) to understand how ICU teams provide backup; and patient-shift level surveys of ICU nurses, physicians, and respiratory therapists, to identify whom clinicians contacted for help that shift. We analyzed and compared these data to gain insight into the frequency, and circumstances surrounding ICU clinicians’ requests for and receipt of backup when providing mechanical ventilation care. Results: Backup behavior was common. Interprofessional backup (e.g. nurse to respiratory therapist) related to specific patient care tasks. Intraprofessional backup (e.g. nurse to nurse) involved team members ‘checking in’ to assist their colleague. Most (57%) survey respondents reported at least one interprofessional contact on day and night shifts, and approximately 25% reported at least one intraprofessional backup contact. We identified distinct backup behavior patterns on day and night shifts. Conclusions: While backup behavior was common, interprofessional backup focused on care aligning with professional roles whereas intraprofessional backup entailed checking-in with team members. Examining how to enhance interprofessional backup through trainings or interventions may improve how teams work and patient care.