Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation

2022 ◽  
Vol 31 (1) ◽  
pp. 54-64
Author(s):  
Michele C. Balas ◽  
Alai Tan ◽  
Brenda T. Pun ◽  
E. Wesley Ely ◽  
Shannon S. Carson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Family Engagement ◽  
Baseline Period ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Collaborative ◽  
Early Mobility ◽  
Percentage Points ◽  
National Quality ◽  
Abcdef Bundle

Background The ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor. Objective To assess the effect of quality improvement collaborative participation on ABCDEF bundle performance. Methods This interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation. Results Complete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility. Conclusions Quality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.

Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit

2020 ◽  
Vol 40 (6) ◽  
pp. 42-51
Author(s):  
Natalie S. McAndrew ◽  
Laura Mark ◽  
Mary Butler
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Patient Care ◽  
Care Delivery ◽  
Family Engagement ◽  
Family Satisfaction ◽  
Family Experience ◽  
Improvement Project ◽  
The Family

Background Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. Objective To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. Methods The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. Results Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. Conclusions This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.

Achieving and Sustaining Ventilator-Associated Pneumonia–Free Time among Intensive Care Units (ICUs): Evidence from the Keystone ICU Quality Improvement Collaborative

2013 ◽  
Vol 34 (7) ◽  
pp. 740-743 ◽  
Author(s):  
Dany S. Matar ◽  
Julius C. Pham ◽  
Thomas A. Louis ◽  
Sean M. Berenholtz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Retrospective Analysis ◽  
Intensive Care Units ◽  
Free Time ◽  
Ventilator Associated Pneumonia ◽  
Quality Improvement Collaborative ◽  
Zero Rate

Our retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative demonstrated that adult ICUs could achieve and sustain a zero rate of ventilator-associated pneumonia (VAP) for a considerable number of ventilator and calendar months. Moreover, the results highlight the importance of adjustment for ventilator-days before comparing VAP-free time among ICUs.

scholarly journals Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit

2020 ◽  
Vol 6 (1) ◽  
pp. e369
Author(s):  
Neha Gupta ◽  
Amber Sones ◽  
Maegan Powell ◽  
Johanna Robbins ◽  
Stephanie Wilson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Early Mobility

scholarly journals Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study

2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Khurram Mustafa ◽  
Hannah Buckley ◽  
Richard Feltbower ◽  
Ramesh Kumar ◽  
Barnaby R. Scholefield
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Retrospective Cohort ◽  
Pediatric Intensive Care ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Pediatric Intensive Care Units ◽  
National Quality

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013–2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02–2.61), age <1 year (OR, 1.84; 95% CI, 1.65–2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042–1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012–1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16–23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91–3.98). Children from Black (OR, 1.68; 95% CI, 1.36–2.07) and Asian (OR, 1.49; 95% CI, 1.28–1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.

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