• Emily M Boltey, Theodore J Iwashyna, Robert C Hyzy, Sam R Watson, Corine Ross, and Deena Kelly Costa.
• Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America. Electronic address: bolteyem@umich.edu.
• J Crit Care. 2019 Jun 1; 51: 192-197.

PurposePoor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination.Materials And MethodsWe administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders.ResultsAmong the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome.ConclusionIncreasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.Copyright © 2019 Elsevier Inc. All rights reserved.

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