ICU team composition and its association with ABCDE implementation in a quality collaborative
Journal of Critical Care(2018)
摘要
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.
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关键词
Patient care team,Ventilator weaning,Patient safety,Quality improvement,Implementation science
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