SESSION TITLE: Patient Safety and Quality Improvement SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Studies have shown that compliance with the evidence-based ABCDEF bundle (SAT, SBT, Choice of Sedation, Delirium Screening, Early Mobility and Family Involvement) allows for earlier liberation from mechanical ventilation, reduced delirium, decreased ICU length of stay, and improved survival. There are multiple factors affecting the execution of SAT/SBT in ICU patients such as interdisciplinary communication and coordination of care between respiratory therapists, nurses, and physicians to ensure proper sequence of the individual components. However, there is limited published research on the effectiveness of bedside sign-off by respiratory therapists in improving the execution of SAT/SBTs. After adopting the ABCDEF bundle in 2015, the ICU team at Orange Regional Medical Center (ORMC), Middletown, NY implemented a “Bedside Wake-Up and Breathe” handoff protocol in June 2016 to improve bundle compliance. The protocol required respiratory therapists to perform independent bedside assessments and communicate with nurses to prepare and execute SATs/SBTs at 6 am before morning rounds. The overall aim of the study was to have a structured protocol that optimized the ABCDEF bundle, enhancing early weaning of mechanically ventilated patients and decreasing ICU length of stay at ORMC. METHODS: We used the ABCDEF protocol established by the ICU Delirium and Cognitive Impairment Study Group at Vanderbilt University Medical Center in order to record SAT/SBT data within the first seven days of the ICU length of stay for ventilated patients. Inclusion and exclusion criteria was based on that of the ABCDEF protocol. We collected data from March 2016 to August 2016 on 103 patients. The pre-intervention group (March-May 2016) included 58 patients and the post-intervention group (June-August 2016) included 45 patients. The intervention was implementation of the “Bedside Wake-Up and Breathe” handoff protocol on mechanically ventilated patients. We used a statistical t-test to compare the average number of SATs and SBTs per mechanically ventilated patient within the first seven days of intubation in the ICU and the average length of stay in the ICU between the pre-intervention and post-intervention period. RESULTS: There was a statistically significant increase in the average number of SATs in the first seven days of intubation between the pre-intervention group (n=58) and post-intervention group (n=45), with 0.74 average SATs per patient in pre and 1.46 average SATs per patient in post (t-test, p-value<0.05). Similarly, there was a statistically significant increase in the average number of SBTs per patient, with 0.74 in pre and 1.15 in post (t-test, p-value<0.05). The pre-intervention length of stay in the ICU was 9.33 days, which was significantly more than the post-intervention length of stay at 5.44 days (t-test, p-value<0.05). CONCLUSIONS: Implementation of the “Bedside Wake-Up and Breathe” handoff protocol, which aimed to facilitate the ABCDEF bundle, successfully increased the average number of SATs/SBTs completed in the first seven days of mechanical ventilation and reduced the average length of stay in the ICU. CLINICAL IMPLICATIONS: Bedside sign-off by respiratory therapists can improve interdisciplinary communication in the ICU and patient outcomes. DISCLOSURE: The following authors have nothing to disclose: Nakia Sarad, Kathleen Holsaeter, Bryony Lucas, Donya Nazery, Harshal Lal, Aamir Gilani No Product/Research Disclosure Information
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