ICU team composition and its association with ABCDE implementation in a quality collaborative

Abstract

Purpose: Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation.

Materials & methods: We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility. We assessed ABCDE implementation using a 5-point Likert ("routine part of every patient's care" - "no plans to implement"). We used ordinal logistic regression to examine team composition and ABCDE implementation, adjusting for confounders and clustering.

Results: From 293 surveys (75% response rate), we found that frequent nurse [OR 6.1 (1.1-34.9)] and physician involvement [OR 4.2 (1.3-13.4)] in SATs, nurse [OR 4.7 (1.6-13.4)] and nursing assistant's involvement [OR 3.9 (1.2-13.5)] in delirium and nurse [OR 2.8 (1.2-6.7)], physician [OR (3.6 (1.2-10.3)], and nursing assistants' involvement [OR 2.3 (1.1-4.8)] in early mobility were significantly associated with higher odds of routine ABCDE implementation.

Conclusions: ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.

Keywords: Implementation science; Patient care team; Patient safety; Quality improvement; Ventilator weaning.

Figure 1

Distribution of team composition in ABCDE practices A=always; M=mostly; S=sometimes; R=rarely; N=never;N/A=not available

Figure 2

Association between physician and nursing aide’s involvement in early mobility and routine ABCDE implementation, when nursing involvement is frequent^{ˆ ˆ}The above figure displays the relationship between physician and nursing aide’s involvement and ABCDE implementation conditional on nursing participation as mostly involved