Diagnostic errors cause significant patient harm and occur among 15 percent of all clinical diagnoses, but research has yet to effectively target, prevent, and mitigate diagnostic errors from occurring. So far, literature has examined how diagnostician decision-makers perform and reach a clinical diagnosis individually. However, the impact of team-based activities on diagnosis is unknown. The purpose of this study is to describe provider perception on how providers come together as a team in order to complete a clinical diagnosis. As a qualitative descriptive study with overtones of grounded theory, 18 semi-structured interviews of medical intensive care unit providers were audio-recorded, transcribed, and coded generating themes of diagnostic teamwork structure and functioning. Diagnostic teams are described using themes of inter-professional and intra-professional teamwork among roles with and without diagnostic team identity. Novel approaches to diagnostic error research, practice implications for current providers, and applications provided for improving education and team training. By providing preliminary insights on the role of teamwork in diagnostic decision-making, this study may assist future studies that improve diagnostic teamwork and prevent diagnostic errors.

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Les patients hospitalisés en réanimation présentent fréquemment des troubles neurologiques (troubles de la vigilance, troubles du sommeil, dysfonctions cognitives multiples, confusion mentale), psychologiques (anxiété, dépression, syndromes délirants), des syndromes douloureux et de l'inconfort. Ces troubles ont en commun : la problématique de leur définition et de leur reconnaissance par l'équipe de réanimation, leur expression fréquente par un comportement d'agitation, une association avec la réponse de stress post-agressive rencontrée au cours des pathologies traitées en réanimation. La physiopathologie de ces troubles est complexe, impliquant à la fois la pathologie qui a déterminé l'hospitalisation du patient en réanimation, ses antécédents médicaux, mais aussi la réanimation elle-même par les thérapeutiques invasives qui y sont utilisées, ainsi que la sédation médicamenteuse ou le coma artificiel. En outre, ces troubles peuvent être associés dans leur expression comme dans leur détermination, certain pouvant être cause ou conséquence d'un autre. L'objectif de cette thèse était de montrer qu'une prise en charge diagnostique et thérapeutique rationalisée de la douleur, des troubles neurologiques et psychologiques était associée à un meilleur pronostic du patient en réanimation. / Patients who are hospitalized in Intensive Care Units (ICU) develop frequent neurological disorders (vigilance disorders, sleep disorders, multiple cognitive disorders, delirium), psychological disorders (anxiety, depression, delusion), pain syndrom and discomfort. These disorders have jointly the problem of their definition and recognition by the ICU team, their frequent expression by an agitated behaviour, an association with the post-aggressive stress response affecting pathologies treated in the ICU setting. The physiopathology of these disorders is complex, implying both the pathology which had determined the admission of the patient to the ICU and his/her medical history, but also either the invasive therapeutics used by the intensive medicine and the administration of sedatives or therapeutic coma. Moreover, theses disorders can be associated either in their expression and their cause, some of them able to be a cause or a consequence of another. The objective of this thesis was to show that a rationalized diagnostic and therapeutic management of pain, neurological and psychological disorders was associated with a better outcome of the patient in the ICU.

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Background Oxygen is one of the most commonly used drugs by anesthesiologists. The World Health Organization (WHO) gave recommendations regarding perioperative oxygen administration, but the practice of oxygen use in anesthesia, critical emergency, and intensive care medicine remains unclear. Methods We conducted an online survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC). The questionnaire consisted of 46 queries appraising the perioperative period, emergency medicine and in the intensive care, knowledge about current recommendations by the WHO, oxygen toxicity, and devices for supplemental oxygen therapy. Results Seven hundred ninety-eight ESAIC members (2.1% of all ESAIC members) completed the survey. Most respondents were board-certified and worked in hospitals with > 500 beds. The majority affirmed that they do not use specific protocols for oxygen administration. WHO recommendations are unknown to 42% of respondents, known but not followed by 14%, and known and followed by 24% of them. Respondents prefer inspiratory oxygen fraction (FiO2) ≥80% during induction and emergence from anesthesia, but intraoperatively < 60% for maintenance, and higher FiO2 in patients with diseased than non-diseased lungs. Postoperative oxygen therapy is prescribed more commonly according to peripheral oxygen saturation (SpO2), but shortage of devices still limits monitoring. When monitoring is used, SpO2 ≤ 95% is often targeted. In critical emergency medicine, oxygen is used frequently in patients aged ≥80 years, or presenting with respiratory distress, chronic obstructive pulmonary disease, myocardial infarction, and stroke. In the intensive care unit, oxygen is mostly targeted at 96%, especially in patients with pulmonary diseases. Conclusions The current practice of perioperative oxygen therapy among respondents does not follow WHO recommendations or current evidence, and access to postoperative monitoring devices impairs the individualization of oxygen therapy. Further research and additional teaching about use of oxygen are necessary.