Journal Article

Exploring the influence of communication and team dynamics relating to infection care on intensive care unit patient discussions: Insights from sociograms and team reflexivity

Charani, E., Bonaconsa, C., Joubert, I., Mendelson, M., Van den Bergh, D.

2025

Overview

Background/Introduction: Multidisciplinary Team (MDT) collaboration in intensive care units (ICU) is complex, necessitating structured communication approaches to optimise discussions, including on infection care. Achieving consistency across teams remains a challenge. This study explores how team dynamics and communication influence patient discussions during ICU ward rounds, using sociograms. Method: Observations of ward rounds were conducted in two ICUs at a tertiary hospital in South Africa. Field notes detailed contextual descriptions, team interactions, and activities. Sociograms mapped and quantified communication episodes and team dynamics. Reflexive feedback promoted team self-assessment on communication practices. Data were thematically analysed, complemented by descriptive statistics. Results: Fifty-four hours of observations, covering 273 patient discussions, generated 38 sociograms and documented 1900 communication episodes. Consultants (43 %,821/1900) and registrars (44 %,835/1900) led discussions, with registrars providing structured updates, including on infection care. Infection care constituted nearly one-third of discussions, however input from nurses, pharmacists, and microbiologists was notably limited despite their active roles in infection-related care. Clear, direct communication correlated with task documentation, while unclear communication led 77 % of tasks undocumented. Infection-related actions were clearly communicated in 93 % of cases. Positioning, side discussions, and interruptions affected communication clarity and focus. The process and reflexivity shifted the view of ward rounds, reframing them as adaptable tools for improving patient care. Discussion: Mapping and quantifying interactions shows the distribution of power and influences in patient discussions. Sociograms and reflexive practices aid self-assessment of interactions to improve team dynamics. Structured communication strategies that include key players, can enhance dynamics, infection care and patient outcomes. •ICU ward round communication is complex, especially in infection-related care.•Hierarchical team norms may marginalise key members with essential expertise.•Spatial positioning and side discussions influence team dynamics and participation.•Sociograms visually map communication patterns and team dynamics.•Sociogram-based reflexive feedback aids self-assessment to improve team dynamics.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Clinical outcomes / Communication / Decision making / Ethnography / Female / Humans / Intensive care / Intensive care unit / Intensive Care Units - organization & administration / Interdisciplinary Communication / Male / Multidisciplinary teams / Patient Care Team - organization & administration / Patient safety / Sociogram / South Africa / Teaching Rounds / Team dynamics / Team reflexivity / Ward round