Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital

Abstract

The ABCDE bundle is an evidence-based, multidisciplinary approach to optimizing patient outcomes in the adult intensive care unit (ICU). The ABCDE bundle incorporates awakening, breathing, coordination, delirium monitoring and management, and early mobility to minimize potentially deleterious effects of prolonged hospitalization, including the development of delirium. Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. The purpose of this evidence-based practice project was to implement the ABCDE bundle in a six-bed general adult ICU of a rural community hospital. Implementation of the bundle decreased average patient hospital length of stay by 1.8 days, reduced length of mechanical ventilation by an average of 1 day, and established a baseline delirium prevalence of 19% over a 3-month time period. The results of this project indicate that the ABCDE bundle can be implemented in rural, community-based hospitals and provides a safe, cost-effective method for enhancing ICU patient outcomes.

Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

“…Upon evaluation of previous work, we were unable to find reports of full ABCDE bundle adherence on ventilator days or DE bundle adherence on ventilator-free days for comparison. Various studies report adherence to individual ABCDE bundle components as follows: A wakening trials 71–100% 8,19,28,29 , B reathing trials 67–100% 19,28,29 , C oordination 87% 29 , D elirium assessment/management 46–92% 8,19,21,28 , and E arly mobility 82% 21,28 . Differing definitions for adherence across studies make comparisons difficult.…”

Improving Health Care for Critically Ill Patients Using an Evidence‐Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation

“…Research and QI efforts using prior versions of the ABCDEF bundle report the feasibility of safely implementing this bundle into everyday ICU care (Balas et al., ; Barnes‐Daly, Phillips, & Ely, ). The bundle is also associated with improvements in a number of important patient‐centered outcomes including increased survival, more days spent alive without delirium or coma, and less days spent on mechanical ventilation and in the hospital (Balas et al., ; Barnes‐Daly et al., ; Kram, DiBartolo, Hinderer, & Jones, ). Importantly, the ABCDEF bundle aligns the interprofessional healthcare team around common care goals as the processes (i.e., interventions) each require the cooperation, coordination, and collaboration of the entire ICU team (Balas et al., , ; Carrothers et al., ; Morandi, Brummel, & Ely, ; Pandharipande, Banerjee, McGrane, & Ely, ; Vasilevskis et al., ).…”

Effects of ABCDE Bundle on Hemodynamics in Patients on Mechanical Ventilation

“…The fundamental solution is to strengthen the monitoring and implementation of the intervention strategy. Based on evidence-based medicine, a sedative and analgesic bundle intervention, referred to as ABCDE bundle [ 3 – 5 ], has been used for ICU patients on mechanical ventilation to improve the quality of medical care and to optimize clinical outcomes. Specifically, ABC refers to the awakening and breathing coordination on a daily basis; D refers to the delirium monitoring/management; and E refers to early exercise/mobility.…”