Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients

Am J Crit Care. 2016 Nov;25(6):535-544. doi: 10.4037/ajcc2016209.


Background: The ABCDE bundle incorporates multidisciplinary measures to improve and/or preserve patients' physical, functional, and neurocognitive status through awakening and breathing coordination, delirium prevention and management, and early physical mobility.

Objectives: To quantify the prevalence and duration of delirium in patients in the intensive care unit (ICU) before and after implementation of the ABCDE bundle.

Methods: Delirium prevalence was defined as the percentage of patients who had at least 1 positive delirium score on the Intensive Care Delirium Screening Checklist (ICDSC) during the ICU stay; delirium duration was the number of days during the ICU stay that a positive ICDSC score was noted. Retrospective data were collected from before and after implementation of the ABCDE bundle.

Results: Of the 159 records reviewed (80 before and 79 after bundle implementation), most were for white men (mean age, 66.3 years). After implementation of the ABCDE bundle, the prevalence of delirium decreased significantly (from 38% to 23%, P = .01) and the mean number of days of delirium decreased significantly (from 3.8 to 1.72 days, P < .001). The number of patients with delirium-free stays increased after bundle implementation.

Conclusions: Implementation of the ABCDE bundle led to significant decreases in the prevalence and duration of delirium in ICU patients.

MeSH terms

  • Aged
  • Critical Care / methods*
  • Delirium / epidemiology*
  • Delirium / prevention & control*
  • Early Ambulation / methods
  • Female
  • Humans
  • Intensive Care Units*
  • Length of Stay / statistics & numerical data
  • Male
  • Maryland / epidemiology
  • Prevalence
  • Retrospective Studies
  • Ventilator Weaning / methods