Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

The ABCDE interprofessional bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility) reduces delirium and weakness in critically ill patients.

To understand the relationship between organizational domains and provider attitudes.

A 1-time electronic survey of 315 care providers in 10 intensive care units across the country to examine associations between organizational domains (policy/protocol factors, unit milieu, tasks, labor quality, labor quantity, and physical environment) and provider attitudes about perceived ease of completion, perceived safety, confidence, and perceived strength of evidence regarding the ABCDE bundle. Spearman correlations (r_s) were used to examine the associations between organizational domains and provider attitude subscales (r_s ≥ 0.32 was considered clinically important).

Protocol attributes (r_s = 0.37-0.58), role clarity (r_s = 0.38-0.59), training/understanding (r_s = 0.33-0.46), coordination (r_s = 0.32-0.46), and peer advocates (r_s = 0.37-0.48) were associated with less difficulty performing the bundle and better confidence, perceived safety, and strength of evidence. Participants also reported less difficulty carrying out the bundle when the team worked well together. Task autonomy was associated with better perceived safety (r_s = 0.35) and confidence (r_s = 0.47) related to the bundle.

Focusing interventions on policy and protocol factors, unit milieu, and task autonomy, which have the strongest associations with providers' attitudes, may facilitate ABCDE bundle uptake.