Juliana Barr1,2, Amir A Ghaferi3,4, Deena Kelly Costa5, Haley K Hedlin6, Victoria Y Ding6, Corine Ross7, Brenda T Pun8, Sam R Watson9, Steven M Asch10,11. 1. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA. 2. Medical Center Line, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA. 3. Institute for Healthcare Policy and Innovation, University of Michigan School of Medicine, Ann Arbor, MI. 4. Stephen M. Ross School of Business, Ann Arbor, MI. 5. Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI. 6. Clinical Trials Program, Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA. 7. Michigan Health & Hospital Association-Keystone Center, Okemos, MI. 8. Critical Illness, Brain Dysfunction and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN. 9. Patient Safety and Quality, Michigan Health & Hospital Association, Okemos, MI. 10. HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA. 11. Department of Medicine and Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
Abstract
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation. DESIGN: We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders' perceptions about organizational characteristics and bundle implementation. SETTING: All (n = 72) acute care hospitals with adult ICUs in Michigan. SUBJECTS: ICU physician and nurse leader pairs from each hospital's main ICU. INTERVENTIONS: We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016. RESULTS: Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation. CONCLUSIONS: We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation. DESIGN: We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders' perceptions about organizational characteristics and bundle implementation. SETTING: All (n = 72) acute care hospitals with adult ICUs in Michigan. SUBJECTS: ICU physician and nurse leader pairs from each hospital's main ICU. INTERVENTIONS: We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016. RESULTS: Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation. CONCLUSIONS: We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
Authors: Anne L Donovan; J Matthew Aldrich; A Kendall Gross; Denise M Barchas; Kevin C Thornton; Hildy M Schell-Chaple; Michael A Gropper; Angela K M Lipshutz Journal: Crit Care Med Date: 2018-06 Impact factor: 7.598
Authors: Michele C Balas; Eduard E Vasilevskis; Keith M Olsen; Kendra K Schmid; Valerie Shostrom; Marlene Z Cohen; Gregory Peitz; David E Gannon; Joseph Sisson; James Sullivan; Joseph C Stothert; Julie Lazure; Suzanne L Nuss; Randeep S Jawa; Frank Freihaut; E Wesley Ely; William J Burke Journal: Crit Care Med Date: 2014-05 Impact factor: 7.598
Authors: Christopher R Dale; Delores A Kannas; Vincent S Fan; Stephen L Daniel; Steven Deem; N David Yanez; Catherine L Hough; Timothy H Dellit; Miriam M Treggiari Journal: Ann Am Thorac Soc Date: 2014-03
Authors: Peter Pronovost; Sean Berenholtz; Todd Dorman; Pam A Lipsett; Terri Simmonds; Carol Haraden Journal: J Crit Care Date: 2003-06 Impact factor: 3.425
Authors: Mary Ann Barnes-Daly; Brenda T Pun; Lori A Harmon; Diane G Byrum; Vishakha K Kumar; John W Devlin; Joanna L Stollings; Kathleen A Puntillo; Heidi J Engel; Patricia J Posa; Juliana Barr; William D Schweickert; Cheryl L Esbrook; Ken D Hargett; Shannon S Carson; J Matthew Aldrich; E Wesley Ely; Michele C Balas Journal: Worldviews Evid Based Nurs Date: 2018-05-05 Impact factor: 2.931