A Multicentre Implementation of a Quality Improvement Initiative to Reduce Delirium in Adult Intensive Care Units: An Interrupted Time Series Analysis
Date
2021-07-27
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Abstract
In 2016, Alberta Health Services implemented the ICU Delirium Initiative in all intensive care units (ICUs) in Alberta. The ICU Delirium Initiative was based on the ABCDEF care bundle and recommended (A) appropriate pain management, (B) daily breaks in continuous sedation along with lowering mechanical ventilation support, (C) appropriate choices for sedation and pain control, (D) routine screening and management of delirium, (E) early mobilization and (F) engagement of family. The purpose of this thesis was to examine the effects of the ABCDEF delirium care bundle on patient-centred outcomes and processes of care among adults admitted to ICUs in Alberta. An interrupted time series analysis using retrospective linked clinical and administrative data from November 2014 to June 2019 was conducted in 14 adult general medical-surgical and one neurological ICU in Alberta. All patient admissions from each site were included after the site had transitioned to the current population-based electronic health documentation system. Provincial outcome trends were compared before and after the ICU Delirium Initiative was implemented in September 2016. The primary outcome was percent of delirium days per ICU. Secondary outcomes included: ever delirium, duration of mechanical ventilation, percent of coma days per ICU, percentage of sedation days using midazolam, adverse events and ICU length of stay and mortality. All outcomes were examined using mixed effects segmented linear regression with ICU site as the random effect. After the intervention, the overall percent of delirium days per ICU was 33.48% [95% Confidence Interval (CI) 29.64-37.31%] in January/February 2017 and decreased significantly by 0.34% every two months (95% CI 0.18-0.50%) following intervention implementation to a final estimate of 28.74% (95% CI 25.22-32.26%) in May/June 2019. The percentage of sedation days using midazolam decreased immediately following the intervention [decrease of 7.58% (95%CI 4.00-11.16%)]. Additionally, there were no significant changes in major adverse events (e.g., patient fall), minor adverse events (e.g., patient removal of peripheral intravenous), duration of mechanical ventilation, percentage of coma days per ICU or ICU mortality. These results suggest that population-based implementation of the ABCDEF bundle is feasible, effective, and safe.
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Keywords
Critical Care, Delirium, ABCDEF, Care bundle, Interrupted time series
Citation
Owen, V. S. (2021). A Multicentre Implementation of a Quality Improvement Initiative to Reduce Delirium in Adult Intensive Care Units: An Interrupted Time Series Analysis (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.