Impact of ABCDE Bundle Implementation in the Intensive Care Unit on Specific Patient Costs

Otusanya, Olufisayo; Hsieh, Szu‐Chuan; Gong, Michelle N.; Gershengorn, Hayley B.

doi:10.1177/08850666211031813

Cited by 4 publications

(5 citation statements)

References 29 publications

(67 reference statements)

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“…Implementation of the ABCDE or ABCDEF bundle has been reported to improve mortality (4, 5, 32, 33), length of ICU or hospital stay (32, 34, 35), duration of mechanical ventilation (33, 34, 36), dosage of sedation (35), delirium or coma (4, 5, 36, 37), restraint-free care (5), hemodynamics (38), ICU readmissions (5), home discharge rates (5, 33), and costs (32, 34, 39). However, the long-term outcomes of implementing the ABCDEF bundle have not been studied to date.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*

Kawakami

Fujitani

Koga

et al. 2023

Critical Care Medicine

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OBJECTIVES: This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes. DESIGN: Secondary analysis of the J-PICS study. SETTING: This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019. PATIENTS: Adult ICU patients who were expected to be on a ventilator for at least 48 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively (p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence (p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence (r = –0.84, R2 = 0.71, p = 0.035) was observed in high-volume centers. CONCLUSIONS: The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*

Kawakami

Fujitani

Koga

et al. 2023

Critical Care Medicine

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“…• 23 studies of care bundles, of which o 18 evaluated the ABCDE(F) bundle (Assess, prevent and manage pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium assessment, prevention and management, Early mobility and exercise, Family engagement and empowerment) (Balas et al, 2013;Balas et al, 2022;Bardwell et al, 2020;Barnes-Daly et al, 2017;Barr et al, 2020;Boehm et al, 2020;Chen et al, 2021a;Collinsworth et al, 2021;Collinsworth et al, 2020;Costa et al, 2018;DeMellow et al, 2020;Hsieh et al, 2019;Lee et al, 2020;Loberg et al, 2022;Negro et al, 2022;Otusanya et al, 2021;Pun et al, 2019;Sosnowski et al, 2018). o Two evaluated a locally developed delirium prevention bundle (Bannon et al, 2018;Smith and Grami, 2016).…”

Section: In the Remaining 89 Implementation Studies We Identifiedmentioning

confidence: 99%

“…• The ICU day (n = 24, 27 %) (Balas et al, 2022;Bardwell et al, 2020;Barr et al, 2020;Boehm et al, 2020;Collinsworth et al, 2021;Collinsworth et al, 2020;DeMellow et al, 2020;Heim et al, 2019;Hsieh et al, 2019;Jablonski et al, 2017;Kamdar et al, 2013;Lee et al, 2020;Liu et al, 2016;Loberg et al, 2022;Ma et al, 2021;Negro et al, 2022;Otusanya et al, 2021;Pun et al, 2019;Smith and Grami, 2016;Sosnowski et al, 2018;Sutton et al, 2021;Tonna et al, 2021;Wessman et al, 2017;Zucco and Damirji, 2018). • The ICU stay (n = 8, 9 %) (Dalal et al, 2016;Dykes et al, 2017;Kodali et al, 2015;Loeslie et al, 2017;Nelson et al, 2006;Noome et al, 2017;Suen et al, 2021;Tonna et al, 2021).…”

Section: Tool Purpose and Objectivesunclassified

Informing the standardising of care for prolonged stay patients in the intensive care unit: A scoping review of quality improvement tools

Allum

Apps²,

Pattison³

et al. 2022

Intensive and Critical Care Nursing

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“…This bundle takes an integrated approach to managing pain (A element), sedation (C element), delirium (D element), mechanical ventilation (B element), and mobility (E element) in ICU patients, and engages patients and families in care processes (F element) (4)(5)(6)(7). Several studies have shown that this bundle significantly improves ICU patient care and outcomes, and reduces healthcare costs (4)(5)(6)(7)(8)(9)(10)(11). The bundle also has a dose-response effect on patient outcomes.…”

mentioning

confidence: 99%

“…Higher levels of bundle compliance are associated with greater reductions in the duration of mechanical ventilation, deep sedation, ICU delirium, and restraint use in ICU patients, along with greater decreases seen in ICU and hospital lengths of stay (LOS), ICU readmissions, hospital mortality, and skilled nursing facility discharges for ICU survivors (4, 5). Improved bundle performance is associated with significant and proportional reductions in ICU and hospital costs (6, 7, 12).…”

mentioning

confidence: 99%

Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System

Barr,

Downs,

Ferrell

et al. 2024

Critical Care Explorations

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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.

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Impact of ABCDE Bundle Implementation in the Intensive Care Unit on Specific Patient Costs

Cited by 4 publications

References 29 publications

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*

Informing the standardising of care for prolonged stay patients in the intensive care unit: A scoping review of quality improvement tools

Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System

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