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Factors Associated With Intensive Care Providers' Performance of the ABCDE Bundle and Clinical Outcomes in Mechanically Ventilated Patients.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Factors Associated With Intensive Care Providers' Performance of the ABCDE Bundle and Clinical Outcomes in Mechanically Ventilated Patients./
Author:	Demellow, Jacqueline Marie.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
Description:	121 p.
Notes:	Source: Dissertations Abstracts International, Volume: 80-05, Section: B.
Contained By:	Dissertations Abstracts International80-05B.
Subject:	Medical personnel. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10845235
ISBN:	9780438628359

Factors Associated With Intensive Care Providers' Performance of the ABCDE Bundle and Clinical Outcomes in Mechanically Ventilated Patients.
Demellow, Jacqueline Marie.

Factors Associated With Intensive Care Providers' Performance of the ABCDE Bundle and Clinical Outcomes in Mechanically Ventilated Patients. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 121 p.

Source: Dissertations Abstracts International, Volume: 80-05, Section: B.

Thesis (Ph.D.)--University of California, Davis, 2018.

This item is not available from ProQuest Dissertations & Theses.

Patients on mechanical ventilation (MV) are at higher risk for developing health care-associated infections and post intensive care syndrome with debilitating functional, cognitive, and mental health problems that can last years after critical illness. The evidence-based bundle comprising the six components of Assess, prevent, and manage pain; Both spontaneous awakening and spontaneous breathing trials; Choice of analgesia and sedation; Delirium assessment, prevention, and management; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) delivered by the intensive care team is safe and effective in reducing hospital mortality, duration of MV, and incidence of delirium. Although previous studies have evaluated both the ICU teams' compliance with the bundle elements and their impact on patient outcomes, it is critical to elucidate factors impeding the delivery of the bundle interventions in MV patients. Accordingly, this study was designed to examine ICU care teams' performance of the ABCDE bundle in MV patients over a 6-month period in 7 community hospitals of a large Western health system. (Due to limitations with electronic health record data, the F element of the bundle was not measured). Specifically, this study aimed to (a) describe the care teams' performance of the ABCDE bundle elements in MV patients over the first 96 hours, (b) identify patient factors associated with improved performance of the care team in the first 96 hours of MV, and (c) examine the effect of the care teams' performance on clinical outcomes. A retrospective observational study design was employed using existing electronic health record data collected from the 7 hospitals. The sample included adult patients who were on MV for greater than 24 hours and admitted to one of 15 ICUs from August 2016 to January 2017. Patients that were moribund or comatose, or who had a chronic tracheostomy, were excluded. Refining the data retrieval algorithm and preparation of the data for statistical analysis took place from May 2017 to February 2018. Composite and individual bundle performance were computed as the proportion of bundle elements actually performed of those that the patient was eligible for, each day during the first 96 hours of MV. Multiple regression analysis was used to determine the association between patient characteristics (age, sex, race, ethnicity, body mass index, admission source) and clinical factors (sedation duration and level) with bundle performance by the team, after adjusting for severity of illness, days on MV, and time elapsed over the study period. Hospital site was used as a fixed effect. Multiple regression and time to event analysis were used to examine the effect of bundle performance by the teams on duration of MV and hospital length of stay (HLOS) in risk-adjusted models. There were 977 adult patients in the sample. Mean composite performance of the bundle by the care teams during the first 96 hours of MV was 66% (+ 14). Overall, mean individual element performance by the care teams was higher for sedation and pain (93 + 16%), awakening (81 + 35%), and breathing (73+ 36%) trials, and lower for delirium and mobility (44 + 35%). There were significant variations in composite performance by site (p < .0001). Composite performance by the care teams was positively associated with patients on sedation for less than 24 hours (p < .0001). Pain assessments were more likely to be performed at least 6 times daily in patients on sedation for less than 2 days (p = .0253). Delirium (p = .0007) and mobility (p = .0064) assessments were more likely to be performed twice daily in patients on sedation for less than 24 hours. Composite performance by the teams was negatively associated with patients of Hispanic ethnicity (p = .0007). Hispanic patients had half the odds of being assessed for delirium by the teams (p = .0236). In a subset of patients on MV for 5 days or less, those who had composite bundle performance by the care team of more than 66% had a shorter mean duration of MV, 1.7240 days (SE = .0760), compared to those with performance scores of 66% or less, at 2.3006 days (SE = .0645), a difference of .5766 days (χ2 = 32.4379, p < .0001). Further, composite performance of 75% or more resulted in patients with a 3.637-day shorter median HLOS (11.948 days; 95% CI [10.063, 13.574]) compared to those with composite performance of less than 75% (15.585 days; 95% CI [13.641, 22.032]; χ2 = 19.0435, p < .0001). This retrospective observational study shows that community hospitals can implement the ABCDE bundle with modest rates of performance over the first 96 hours of MV and improve clinical outcomes, yet there is room for improvement. (Abstract shortened by ProQuest.).

ISBN: 9780438628359Subjects--Topical Terms:

774747
Medical personnel.
Subjects--Index Terms:

Abcdef bundle

Factors Associated With Intensive Care Providers' Performance of the ABCDE Bundle and Clinical Outcomes in Mechanically Ventilated Patients.
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520 $a Patients on mechanical ventilation (MV) are at higher risk for developing health care-associated infections and post intensive care syndrome with debilitating functional, cognitive, and mental health problems that can last years after critical illness. The evidence-based bundle comprising the six components of Assess, prevent, and manage pain; Both spontaneous awakening and spontaneous breathing trials; Choice of analgesia and sedation; Delirium assessment, prevention, and management; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) delivered by the intensive care team is safe and effective in reducing hospital mortality, duration of MV, and incidence of delirium. Although previous studies have evaluated both the ICU teams' compliance with the bundle elements and their impact on patient outcomes, it is critical to elucidate factors impeding the delivery of the bundle interventions in MV patients. Accordingly, this study was designed to examine ICU care teams' performance of the ABCDE bundle in MV patients over a 6-month period in 7 community hospitals of a large Western health system. (Due to limitations with electronic health record data, the F element of the bundle was not measured). Specifically, this study aimed to (a) describe the care teams' performance of the ABCDE bundle elements in MV patients over the first 96 hours, (b) identify patient factors associated with improved performance of the care team in the first 96 hours of MV, and (c) examine the effect of the care teams' performance on clinical outcomes. A retrospective observational study design was employed using existing electronic health record data collected from the 7 hospitals. The sample included adult patients who were on MV for greater than 24 hours and admitted to one of 15 ICUs from August 2016 to January 2017. Patients that were moribund or comatose, or who had a chronic tracheostomy, were excluded. Refining the data retrieval algorithm and preparation of the data for statistical analysis took place from May 2017 to February 2018. Composite and individual bundle performance were computed as the proportion of bundle elements actually performed of those that the patient was eligible for, each day during the first 96 hours of MV. Multiple regression analysis was used to determine the association between patient characteristics (age, sex, race, ethnicity, body mass index, admission source) and clinical factors (sedation duration and level) with bundle performance by the team, after adjusting for severity of illness, days on MV, and time elapsed over the study period. Hospital site was used as a fixed effect. Multiple regression and time to event analysis were used to examine the effect of bundle performance by the teams on duration of MV and hospital length of stay (HLOS) in risk-adjusted models. There were 977 adult patients in the sample. Mean composite performance of the bundle by the care teams during the first 96 hours of MV was 66% (+ 14). Overall, mean individual element performance by the care teams was higher for sedation and pain (93 + 16%), awakening (81 + 35%), and breathing (73+ 36%) trials, and lower for delirium and mobility (44 + 35%). There were significant variations in composite performance by site (p < .0001). Composite performance by the care teams was positively associated with patients on sedation for less than 24 hours (p < .0001). Pain assessments were more likely to be performed at least 6 times daily in patients on sedation for less than 2 days (p = .0253). Delirium (p = .0007) and mobility (p = .0064) assessments were more likely to be performed twice daily in patients on sedation for less than 24 hours. Composite performance by the teams was negatively associated with patients of Hispanic ethnicity (p = .0007). Hispanic patients had half the odds of being assessed for delirium by the teams (p = .0236). In a subset of patients on MV for 5 days or less, those who had composite bundle performance by the care team of more than 66% had a shorter mean duration of MV, 1.7240 days (SE = .0760), compared to those with performance scores of 66% or less, at 2.3006 days (SE = .0645), a difference of .5766 days (χ2 = 32.4379, p < .0001). Further, composite performance of 75% or more resulted in patients with a 3.637-day shorter median HLOS (11.948 days; 95% CI [10.063, 13.574]) compared to those with composite performance of less than 75% (15.585 days; 95% CI [13.641, 22.032]; χ2 = 19.0435, p < .0001). This retrospective observational study shows that community hospitals can implement the ABCDE bundle with modest rates of performance over the first 96 hours of MV and improve clinical outcomes, yet there is room for improvement. (Abstract shortened by ProQuest.).
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