PMID- 38250248
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240123
IS  - 2639-8028 (Electronic)
IS  - 2639-8028 (Linking)
VI  - 6
IP  - 1
DP  - 2024 Jan
TI  - Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following 
      Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare 
      System.
PG  - e1001
LID - 10.1097/CCE.0000000000001001 [doi]
LID - e1001
AB  - OBJECTIVES: To measure how the ICU Liberation Bundle (aka ABCDEF Bundle or the 
      Bundle) affected clinical outcomes in mechanically ventilated (MV) adult ICU 
      patients, as well as bundle sustainability and spread across a healthcare system. 
      DESIGN: We conducted a multicenter, prospective, cohort observational study to 
      measure bundle performance versus patient outcomes and sustainability in 11 adult 
      ICUs at six community hospitals. We then prospectively measured bundle spread and 
      performance across the other 28 hospitals of the healthcare system. SETTING: A 
      large community-based healthcare system. PATIENTS: In 11 study ICUs, we enrolled 
      1,914 MV patients (baseline n = 925, bundle performance/outcomes n = 989), 3,019 
      non-MV patients (baseline n = 1,323, bundle performance/outcomes n = 1,696), and 
      2,332 MV patients (bundle sustainability). We enrolled 9,717 MV ICU patients in 
      the other 28 hospitals to assess bundle spread. INTERVENTIONS: We used 
      evidence-based strategies to implement the bundle in all 34 hospitals. 
      MEASUREMENTS AND MAIN RESULTS: We compared outcomes for the 12-month baseline and 
      bundle performance periods. Bundle implementation reduced ICU length of stay 
      (LOS) by 0.5 days (p = 0.02), MV duration by 0.6 days (p = 0.01), and ICU LOS 
      greater than or equal to 7 days by 18.1% (p < 0.01). Performance period bundle 
      compliance was compared with the preceding 3-month baseline compliance period. 
      Compliance with pain management and spontaneous awakening trial (SAT) and 
      spontaneous breathing trial (SBT) remained high, and reintubation rates remained 
      low. Sedation assessments increased (p < 0.01) and benzodiazepine sedation use 
      decreased (p < 0.01). Delirium assessments increased (p = 0.02) and delirium 
      prevalence decreased (p = 0.02). Patient mobilization and ICU family engagement 
      did not significantly improve. Bundle element sustainability varied. SAT/SBT 
      compliance dropped by nearly half, benzodiazepine use remained low, sedation and 
      delirium monitoring and management remained high, and patient mobility and family 
      engagement remained low. Bundle compliance in ICUs across the healthcare system 
      exceeded that of study ICUs. CONCLUSIONS: The ICU Liberation Bundle improves 
      outcomes in MV adult ICU patients. Evidence-based implementation strategies 
      improve bundle performance, spread, and sustainability across large healthcare 
      systems.
FAU - Barr, Juliana
AU  - Barr J
AD  - Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 
      Palo Alto, CA.
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford 
      University School of Medicine, Stanford, CA.
FAU - Downs, Brenda
AU  - Downs B
AD  - Critical Care, Emergency Services and Sepsis, CommonSpirit Health, Phoenix, AZ.
FAU - Ferrell, Ken
AU  - Ferrell K
AD  - Data Science, CommonSpirit Health, Phoenix, AZ.
FAU - Talebian, Mojdeh
AU  - Talebian M
AD  - Data Science Department, CommonSpirit Health, Phoenix, AZ.
AD  - ICU and Pulmonary Services, Dignity Health, Sequoia Hospital, Redwood City, CA.
FAU - Robinson, Seth
AU  - Robinson S
AD  - ICU, Dignity Health, Woodland Memorial Hospital, Woodland, CA.
FAU - Kolodisner, Liesl
AU  - Kolodisner L
AD  - Quality Reporting and Information, CommonSpirit Health, Phoenix, AZ.
FAU - Kendall, Heather
AU  - Kendall H
AD  - Gordon and Betty Moore Foundation Grants, Care Management, Roseville, CA.
FAU - Holdych, Janet
AU  - Holdych J
AD  - Acute Care Quality, CommonSpirit Health, Glendale, CA.
LA  - eng
PT  - Journal Article
DEP - 20240119
PL  - United States
TA  - Crit Care Explor
JT  - Critical care explorations
JID - 101746347
PMC - PMC10798758
OTO - NOTNLM
OT  - ABCDEF Bundle
OT  - critical care outcomes
OT  - implementation science
OT  - intensive care
OT  - intensive care unit liberation
OT  - quality improvement
COIS- The authors have disclosed that they do not have any potential conflicts of 
      interest.
EDAT- 2024/01/22 06:42
MHDA- 2024/01/22 06:43
PMCR- 2024/01/19
CRDT- 2024/01/22 05:17
PHST- 2024/01/22 06:43 [medline]
PHST- 2024/01/22 06:42 [pubmed]
PHST- 2024/01/22 05:17 [entrez]
PHST- 2024/01/19 00:00 [pmc-release]
AID - 10.1097/CCE.0000000000001001 [doi]
PST - epublish
SO  - Crit Care Explor. 2024 Jan 19;6(1):e1001. doi: 10.1097/CCE.0000000000001001. 
      eCollection 2024 Jan.