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Am J Crit Care. 2017 May;26(3):e18-e28. doi: 10.4037/ajcc2017297.

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle.

Author information

1
Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University, Nashville, Tennessee. Eduard E. Vasilevskis is a staff physician, VA Tennessee Valley Healthcare System, GRECC and an assistant professor of medicine, Center for Health Services Research, Vanderbilt University. Mary S. Dietrich is a professor of biostatistics, School of Nursing and School of Medicine, Vanderbilt University. Nancy Wells is a research professor, Vanderbilt University School of Nursing and Vanderbilt University Medical Center, Nashville, Tennessee. E. Wesley Ely is associate director, VA Tennessee Valley Healthcare System, GRECC, and a professor, Department of Medicine and Center for Health Services Research, Vanderbilt University. Pratik Pandharipande is a professor of anesthesiology and surgery, Vanderbilt University School of Medicine and a staff physician, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System. Lorraine C. Mion is a research professor and interim director of the Center of Excellence in Critical and Complex Care, The Ohio State University School of Nursing, Columbus, Ohio. leanne.boehm@vanderbilt.edu.
2
Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University, Nashville, Tennessee. Eduard E. Vasilevskis is a staff physician, VA Tennessee Valley Healthcare System, GRECC and an assistant professor of medicine, Center for Health Services Research, Vanderbilt University. Mary S. Dietrich is a professor of biostatistics, School of Nursing and School of Medicine, Vanderbilt University. Nancy Wells is a research professor, Vanderbilt University School of Nursing and Vanderbilt University Medical Center, Nashville, Tennessee. E. Wesley Ely is associate director, VA Tennessee Valley Healthcare System, GRECC, and a professor, Department of Medicine and Center for Health Services Research, Vanderbilt University. Pratik Pandharipande is a professor of anesthesiology and surgery, Vanderbilt University School of Medicine and a staff physician, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System. Lorraine C. Mion is a research professor and interim director of the Center of Excellence in Critical and Complex Care, The Ohio State University School of Nursing, Columbus, Ohio.

Abstract

BACKGROUND:

The ABCDE interprofessional bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility) reduces delirium and weakness in critically ill patients.

OBJECTIVE:

To understand the relationship between organizational domains and provider attitudes.

METHODS:

A 1-time electronic survey of 315 care providers in 10 intensive care units across the country to examine associations between organizational domains (policy/protocol factors, unit milieu, tasks, labor quality, labor quantity, and physical environment) and provider attitudes about perceived ease of completion, perceived safety, confidence, and perceived strength of evidence regarding the ABCDE bundle. Spearman correlations (rs) were used to examine the associations between organizational domains and provider attitude subscales (rs ≥ 0.32 was considered clinically important).

RESULTS:

Protocol attributes (rs = 0.37-0.58), role clarity (rs = 0.38-0.59), training/understanding (rs = 0.33-0.46), coordination (rs = 0.32-0.46), and peer advocates (rs = 0.37-0.48) were associated with less difficulty performing the bundle and better confidence, perceived safety, and strength of evidence. Participants also reported less difficulty carrying out the bundle when the team worked well together. Task autonomy was associated with better perceived safety (rs = 0.35) and confidence (rs = 0.47) related to the bundle.

CONCLUSIONS:

Focusing interventions on policy and protocol factors, unit milieu, and task autonomy, which have the strongest associations with providers' attitudes, may facilitate ABCDE bundle uptake.

PMID:
28461551
PMCID:
PMC5693381
DOI:
10.4037/ajcc2017297
[Indexed for MEDLINE]
Free PMC Article

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