Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation.

Area of Science:

• Critical care medicine
• Quality improvement science
• Patient safety

Background:

• The ABCDEF bundle is proven to enhance intensive care unit (ICU) outcomes.
• However, widespread adoption of the ABCDEF bundle into clinical practice remains a significant challenge.

Purpose of the Study:

• To evaluate the impact of participating in a quality improvement collaborative on the performance of the ABCDEF bundle.
• To identify specific elements of the bundle that benefit most from collaborative interventions.

Main Methods:

• An interrupted time series analysis was conducted using 20 months of data from 15,226 adult ICU patients across 68 US ICUs.
• Segmented regression models analyzed complete and individual bundle element performance before and after collaborative initiation.

Main Results:

• Complete ABCDEF bundle performance increased from under 4% at baseline to 12% by the study's end.
• Immediate improvements were observed for pain assessment, sedation assessment, and family engagement post-collaboration initiation.
• Monthly increases in performance were noted, though rates for spontaneous awakening/breathing trials and early mobility remained low.

Conclusions:

• Quality improvement collaboratives can lead to clinically relevant, albeit modest and variable, improvements in ABCDEF bundle adherence.
• Sustained efforts are needed to enhance the implementation of sedation, mechanical ventilation, and early mobility practices within the bundle.