• Victoria S Owen, Selvi Sinnadurai, Jeanna Morrissey, Heather Colaco, Patty Wickson, Donalda Dyjur, Melissa Redlich, Barbara O'Neill, David A Zygun, Christopher J Doig, Jo Harris, Danny J Zuege, Henry T Stelfox, Peter D Faris, Kirsten M Fiest, Daniel J Niven, and Critical Care Strategic Clinical Network.
• Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
• J Crit Care. 2024 Jun 1; 81: 154524154524.

PurposeThe ABCDEF bundle may improve delirium outcomes among intensive care unit (ICU) patients, however population-based studies are lacking. In this study we evaluated effects of a quality improvement initiative based on the ABCDEF bundle in adult ICUs in Alberta, Canada.Material And MethodsWe conducted a pre-post, registry-based clinical trial, analysed using interrupted time series methodology. Outcomes were examined via segmented linear regression using mixed effects models. The main data source was a population-based electronic health record.Results44,405 consecutive admissions (38,400 unique patients) admitted to 15 general medical/surgical and/or neurologic adult ICUs between 2014 and 2019 were included. The proportion of delirium days per ICU increased from 30.24% to 35.31% during the pre-intervention period. After intervention implementation it decreased significantly (bimonthly decrease of 0.34%, 95%CI 0.18-0.50%, p < 0.01) from 33.48% (95%CI 29.64-37.31%) in 2017 to 28.74% (95%CI 25.22-32.26%) in 2019. The proportion of sedation days using midazolam demonstrated an immediate decrease of 7.58% (95%CI 4.00-11.16%). There were no significant changes in duration of invasive ventilation, proportion of partial coma days, ICU mortality, or potential adverse events.ConclusionsAn ABCDEF delirium initiative was implemented on a population-basis within adult ICUs and was successful at reducing the prevalence of delirium.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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