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

Dimens Crit Care Nurs. 2015 Sep-Oct;34(5):250-8. doi: 10.1097/DCC.0000000000000129.


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.

MeSH terms

  • Critical Care Nursing / methods*
  • Delirium / prevention & control*
  • Early Ambulation
  • Evidence-Based Nursing
  • Hospitals, Community
  • Hospitals, Rural
  • Humans
  • Intensive Care Units*
  • Length of Stay*
  • Maryland
  • Program Evaluation
  • Respiration, Artificial / statistics & numerical data