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

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

doi:10.1016/j.jcrc.2025.155127

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

J Crit Care. 2025 May 29:89:155127. doi: 10.1016/j.jcrc.2025.155127. Online ahead of print.

Authors

C Bonaconsa¹, E Charani², D Van den Bergh³, I Joubert⁴, M Mendelson³

Affiliations

¹ Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Electronic address: candice.bonaconsa@uct.ac.za.
² Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom. Electronic address: esmita.charani@uct.ac.za.
³ Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
⁴ Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa.

PMID: 40446731
DOI: 10.1016/j.jcrc.2025.155127

Abstract

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.

Keywords: Communication; Intensive care unit; Sociogram; Team dynamics; Team reflexivity; Ward round.