Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

Abstract

Purpose: Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. Materials and Methods: We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders. Results: Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome. Conclusion: Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.

Implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey

“…Studies have shown that a lack of knowledge and awareness is a major factor affecting employees’ ABCDE bundle behavior. 25,26 Healthcare professionals with less working years and a junior professional title may receive more training and are more willing to accept new concepts during recruitment. Our study also showed that the nurses’ scores of ABCDE bundle behavior were higher than those of physicians.…”

A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge

“…Scores are on a scale of strongly disagree (0) to strongly agree (7), with higher scores indicating provider perceptions of higher quality teamwork during a task (ie, discharging the patient) 32. The scale has previously been validated 28 39–42. Cronbach alpha value was 0.87.…”

A Scoping Review of Implementation Science in Adult Critical Care Settings

“…Twelve studies reported use of a single strategy for EBP implementation. Single strategy approaches included auditing and feedback ( 23 , 26 , 27 , 65 , 66 ), facilitators and barriers ( 15 , 16 , 18 , 32 ), financial incentives ( 36 ), building a coalition ( 19 ), and educational training ( 72 ). Across all types of designs, none specifically explored the role of mediators for their effect on implementation or clinical outcomes or as causal components in the relationship between implementation strategies and outcomes.…”

“…The majority of studies ( n = 13) evaluated more than one IS strategy, with auditing and feedback incorporated most often across studies ( n = 13) ( 14 , 17 , 20 – 22 , 25 – 27 , 29 – 31 , 33 ). Eight studies evaluated a single implementation strategy ( 15 , 16 , 18 , 19 , 23 , 26 , 27 , 32 ), namely identifying facilitators and barriers ( 15 , 16 , 18 , 32 ), building a coalition ( 19 ), and auditing and feedback ( 22 , 26 , 27 ).…”

“…Only one study included adoption as an implementation outcome ( 14 ). Additionally, a subset of studies specifically evaluated facilitators and barriers to implementation ( 15 , 16 ), effective implementation strategies ( 28 ), or perceptions of auditing and feedback as a strategy using a qualitative approach ( 27 ). In addition to implementation outcomes, five of the studies also evaluated clinical outcomes; these included VAP rates and/or ventilator days ( 14 , 33 ), mortality ( 30 ), and CLABSI rates ( 21 , 22 ).…”