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


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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.HighlightsThis is the first paper to examine ICU team composition and ABCDE implementation.We find variation in how frequently each team member is involved in ABCDE.Some team members are perceived to be more involved in some activities than others.These data suggest a need for role clarification and complex coordination.ICUs with high levels of ABCDE may create teams that work from shared mental models.

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