(1300) A Systemwide Evolution for Changing the Culture of Critical Care Using Our ABCs

Introduction: Standardized approaches to critical care include but are not limited to intensive care unit (ICU) admission criteria, rounding tools, and approaches to patient care, such as the ICU Liberation initiative. The unification of 13 community hospitals into one system left opportunity for improvement in the aforementioned measures. A multidisciplinary team worked to develop intensive care unit admission criteria, a rounding tool that highlighted the components of the ABCDEF Bundle, and targeted education for all critical care staff on the bundle elements with the goal of advancing patient care.

Methods: This system-wide transformation occurred across 13 community hospitals with various adult critical care units including cardiac, medical, neurological, and trauma. Patients admitted to these units were included in the study, with a rolling enrollment of hospitals over the course of two years. The study used descriptive statistics to analyze outcomes before and after implementation of the ICU Liberation rounding tool and bundle education. Outcomes were presented as a percent change over time and as ratios of expected versus actual. Data was extracted using third-party software that predicts outcomes based on patient APACHE scores at the time of admission.

Results: Data was compared from the first quarter of 2022 to the second quarter of 2024. Low risk ICU admission decreased by 29% using the revised critical care admission criteria. Median ventilator days decreased from 1.6 days to 1.3 days, an improvement of 12.5%. Intensive care unit length of stay decreased from 0.82 of expected (or predicted) to 0.68, a change of 17%. Mortality decreased by 37%, as seen in the change from 1.16 of expected deaths to 0.73.

Conclusions: According to the change in outcomes seen using the data, the application of the critical care admission criteria, ICU Liberation Rounding tool, and ABCDEF bundle has decreased low risk admission, median ventilator days, ICU length of stay, and mortality. Application of the changes has improved patient outcomes despite rolling enrollment of facilities and other adversities faced in a large initiative that requires a change in culture and practice. Results will continue to be analyzed as expansive education is provided and use of the ABCDEF Bundle becomes more familiar.