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A Survey of Implementation of ABCDE Protocols
Rita N Bakhru1, Kathleen J Propert2, Steven M Kawut3,4
1Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Journal of Intensive Care Medicine
|June 22, 2022
Summary
The ABCDE bundle improves patient outcomes, but implementation varies. Multidisciplinary rounds and medical ICUs showed higher adoption of spontaneous awakening and breathing trials, highlighting the importance of team communication for protocol success.
Area of Science:
- Critical care medicine
- Evidence-based practice implementation
- Healthcare quality improvement
Background:
- The ABCDE bundle (Spontaneous Awakening Trials, Spontaneous Breathing Trials, Delirium assessment/management, early mobility) improves patient outcomes.
- A significant gap exists between evidence-based medicine dissemination and clinical implementation.
Purpose of the Study:
- To assess the prevalence of ABCDE protocol adoption in Pennsylvania ICUs.
- To identify factors influencing the implementation of the ABCDE bundle.
Main Methods:
- A survey was developed and validated to assess ABCDE protocol implementation, including protocol presence, standardization, timing, and adherence.
- Data on ICU staffing and hospital-level factors were collected.
- Multivariable logistic and ordinal regression analyses were performed on data from 100 Pennsylvania hospitals.
Main Results:
- 86% of responding ICUs had Spontaneous Awakening Trial protocols, 60% had Spontaneous Breathing Trial protocols, 43% had delirium protocols, and 27% had early mobility protocols.
- Medical ICUs (OR 3.48) and the presence of multidisciplinary rounds (OR 4.97) were associated with greater ABCDE protocol component adoption.
- A 69% response rate was achieved from 144 surveyed Pennsylvania ICUs.
Conclusions:
- ABCDE bundle protocol implementation is variable across Pennsylvania.
- Effective team communication is crucial for successful implementation of these critical care protocols.
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