A landmark study led by the University of Nebraska Medical Center (UNMC) is underway to determine the best strategies for implementing the ABCDEF Bundle, a set of evidence-based interventions, in intensive care units (ICUs). The multisite study, involving Nebraska Medicine, The Ohio State University Wexner Medical Center, and the University of Iowa Hospitals and Clinics, aims to bridge the gap between research and clinical practice, ensuring that ICU patients receive optimal care.
The ABCDEF Bundle encompasses several key interventions, including assessing and managing pain, interrupting sedation, and increasing patient mobility. "The ABCDEF Bundle is considered the standard of care and should be given to every single patient, every single day in the ICU whether or not they are on the ventilator," said Dr. Michele Balas, associate dean of research at the UNMC College of Nursing, who leads the study.
Addressing Implementation Challenges
Despite its proven benefits, the ABCDEF Bundle is not consistently implemented in all ICUs due to various challenges, including workforce shortages. The study seeks to identify the most effective methods for overcoming these barriers and ensuring that patients receive the bundle's comprehensive care.
"We now know a single episode of acute confusion in the hospital elevates your risk for long-term cognitive impairment that can be as severe as dementia or traumatic brain injury. It’s not a single event," Dr. Balas noted, highlighting the importance of interventions like the ABCDEF bundle in preventing complications like delirium.
Study Design and Data Collection
The five-year study, funded by the National Institutes of Health (NIH), involves mechanically ventilated ICU patients across 12 participating ICUs. Six units will implement and track the ABCDEF Bundle using an electronic dashboard to monitor compliance. The remaining six ICUs will receive an additional registered day nurse to assist with bundle implementation.
Data collection will continue until early 2027, after which researchers will analyze the data to determine which method is most effective in translating evidence-based research into clinical practice. The study is powered by PCORnet, the National Patient-Centered Clinical Research Network.
Impact on Patient Care
The findings from this study are expected to inform hospital systems and healthcare teams on how to best implement the ABCDEF Bundle, ultimately improving patient outcomes and reducing the risk of long-term complications. "I’m in it to improve patient care and patient-centered outcomes," Dr. Balas stated.
Dr. Carol Geary, assistant professor in pathology/microbiology and UNMC PCORnet principal investigator, emphasized the study's significance for UNMC and patient care, stating, "This is an important study for UNMC, the college of nursing and patient care and can help move evidence-based research into routine health care."
