Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation

Author:

Balas Michele C.1,Tan Alai2,Pun Brenda T.3,Ely E. Wesley4,Carson Shannon S.5,Mion Lorraine6,Barnes-Daly Mary Ann7,Vasilevskis Eduard E.8

Affiliation:

1. Michele C. Balas is an associate dean of research and Dorothy Hodges Olsen Distinguished Professor of Nursing at the University of Nebraska Medical Center College of Nursing, Omaha, Nebraska.

2. Alai Tan is a research professor, Center for Research and Health Analytics, College of Nursing, The Ohio State University, Columbus, Ohio.

3. Brenda T. Pun is director of data quality at the Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee.

4. E. Wesley Ely is a professor at the Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, and at the Tennessee Valley Veterans Affairs Geriatric Research Education and Clinical Center, Nashville, Tennessee.

5. Shannon S. Carson is a professor at the University of North Carolina School of Medicine, Chapel Hill, North Carolina.

6. Lorraine Mion is a research professor, Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing.

7. Mary Ann Barnes-Daly is a clinical performance improvement consultant at Sutter Health, Sacramento California.

8. Eduard E. Vasilevskis is an associate professor, Division of General Internal Medicine and Public Health, Section of Hospital Medicine; the Center for Health Services Research; the Center for Quality Aging; and the Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, and a staff physician, Tennessee Valley Veterans Affairs Geriatric Research Education and Clinical Center.

Abstract

Background The ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor. Objective To assess the effect of quality improvement collaborative participation on ABCDEF bundle performance. Methods This interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation. Results Complete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility. Conclusions Quality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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