Emily M Boltey1, Theodore J Iwashyna2, Robert C Hyzy3, Sam R Watson4, Corine Ross4, Deena Kelly Costa5. 1. Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America. Electronic address: bolteyem@umich.edu. 2. Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, Ann Arbor, MI, United States of America. 3. Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, MI, United States of America. 4. Michigan Health and Hospital Association, Lansing, MI, United States of America. 5. Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America.
Abstract
PURPOSE: Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. MATERIALS AND METHODS: We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders. RESULTS: Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome. CONCLUSION: Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.
PURPOSE: Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. MATERIALS AND METHODS: We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders. RESULTS: Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome. CONCLUSION: Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.
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