Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

2019 ◽  
Vol 39 (1) ◽  
pp. 46-60 ◽  
Author(s):  
Michele C. Balas ◽  
Brenda T. Pun ◽  
Chris Pasero ◽  
Heidi J. Engel ◽  
Christiane Perme ◽  
...  
Keyword(s):  
Performance Metrics ◽  
Implementation Strategies ◽  
Quality Improvement Initiative ◽  
Dissemination And Implementation ◽  
Collaborative Teams ◽  
Everyday Clinical Practice ◽  
Early Mobility ◽  
Spontaneous Breathing Trials ◽  
Family Engagement And Empowerment ◽  
Abcdef Bundle

Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.

Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative

2019 ◽  
Vol 39 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Joanna L. Stollings ◽  
John W. Devlin ◽  
Brenda T. Pun ◽  
Kathleen A. Puntillo ◽  
Tamra Kelly ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Quality Improvement Initiative ◽  
Dissemination And Implementation ◽  
Patient Centered ◽  
Early Mobility ◽  
Interprofessional Teamwork ◽  
National Quality ◽  
Spontaneous Breathing Trials ◽  
Family Engagement And Empowerment ◽  
Abcdef Bundle

The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.

Adaptation in Dissemination and Implementation Science

2017 ◽  
Author(s):  
Ana A. Baumann ◽  
Leopoldo J. Cabassa ◽  
Shannon Wiltsey Stirman
Keyword(s):  
Implementation Science ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Research And Practice ◽  
Implementation Outcomes ◽  
Dissemination And Implementation Science ◽  
Dissemination And Implementation Research

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.

The Role of Economic Evaluation in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Ramesh Raghavan
Keyword(s):  
Service Providers ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Point Of View ◽  
Dissemination And Implementation ◽  
Economic Point ◽  
Open Questions ◽  
Public Health Organizations ◽  
Quality Health ◽  
Dissemination And Implementation Research

This chapter presents an overview of how D&I research can be evaluated from an economic point of view. Dissemination and implementation imposes costs upon knowledge purveyors, provider organizations, public health organizations, and payers (including governments). However, whether these added costs will result in improved service delivery and, perhaps more importantly, client outcomes and improvements in population health remain as open questions. If emerging studies reveal that defined implementation strategies are more cost effective than “usual” implementation, then policymakers and service providers will need to resource these added costs of implementation in order to assure the success and sustainability of high-quality health services over the long term.

scholarly journals Putting veterans with heart failure FIRST improves follow-up and reduces readmissions

2019 ◽  
Vol 8 (1) ◽  
pp. e000386 ◽  
Author(s):  
Serena Michelle Ogunwole ◽  
Jason Phillips ◽  
Amber Gossett ◽  
John Richard Downs
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Best Practices ◽  
Implementation Strategies ◽  
Quality Improvement Initiative ◽  
Medicine Department ◽  
High Risk Patients ◽  
Resource Limited ◽  
Risk Patients

BackgroundDespite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources.MethodsThis was a medical resident-driven initiative. A process map of the discharge and follow-up appointment process was created that identified multiple areas for improvement. Based on these findings, a two-part intervention was implemented. First, heart failure discharge education with focus on early follow-up was disseminated to providers throughout the internal medicine department. Subsequently, improved identification of high-risk patients (Failure Intervention Risk StratificationTool) and innovative use of the existing electronic medical record (EMR) were employed to sustain and improve on gains from the first set of interventions.ResultsWe increased our 7-day follow-up rate from 47% to 57% (p=0.429) and decreased the average time to follow-up from 17.6 days to 8.7 days (p=0.016) following the first intervention. The percentage of patients readmitted within 30 days after discharge at baseline (2012–2013) and following the first intervention (education and standardisation of follow-up scheduling) and second intervention (risk stratification, intensive follow-up and EMR change) was 25% and 21%, respectively. Thirty-day mortality rate decreased from 10% in 2011 to 7.16% in December 2015.ConclusionClose hospital discharge follow-up and identification of high-risk patients with CHF are useful approaches to reduce readmissions. Using the existing EMR tool for identifying high-risk patients and improving adherence to best practices is an effective intervention. In patients with CHF these strategies improved time to follow-up and 30-day readmissions while decreasing mortality.

scholarly journals Using evidence-based dissemination and implementation strategies to improve routine communication between general practitioners and community mental health teams

2004 ◽  
Vol 28 (1) ◽  
pp. 8-11 ◽  
Author(s):  
Tracy White ◽  
Sarah Marriott
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
General Practitioners ◽  
Good Practice ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Care Providers ◽  
Mental Health Team ◽  
Clinical Communication

Aims and MethodTo improve the quality of written communication between general practitioners (GPs) and community mental health team (CMHT) members concerning patients newly referred to two inner-city CMHTs. Following a benchmark audit of a random sample of referral and assessment letters, locally agreed good practice protocols were shared widely, accompanied by a dissemination and implementation strategy.ResultsSignificant improvements occurred in both GP and CMHT letters; these were most dramatic after 1 year, but tailed off considerably in the second year despite continued efforts to implement the protocols' standards.Clinical ImplicationsPlanned dissemination and implementation strategies can help to improve routine clinical communication between CMHTs and GPs through the use of good practice protocols, thus improving shared working between primary and secondary care providers.

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