Automating the ABCDE Ventilator Bundle in the ICU

Background

Mechanical ventilation [MV], while often necessary, can lead to a multitude of hospital-acquired conditions such as ICU-associated delirium, which has been shown to be strongly associated with increased morbidity and mortality rates both while in the hospital and post-acute care. Further, MV is a prime target for improving both patient outcomes and cost savings, since MV is the single biggest determinant in ICU Length of Stay [LOS], the single greatest driver of cost for an inpatient admission. Current evidence shows that coordination between different care team disciplines to screen and conduct weaning trials can improve patient outcomes, but they are largely performed manually and on a set schedule, translating into many missed opportunities to improve those very outcomes.

Technology Overview

Researchers at the University of Pennsylvania have created the ABCDE app to continuously screen patients based on data in the electronic health record and alert the care team upon the patient reaching clinical readiness for weaning from sedation and ventilation. This information plus delirium scoring and progress with exercise is displayed in real-time on an electronic dashboard for review by ICU teams and ICU leadership. Simultaneously, alerts are sent to the respiratory therapist [RT] and registered nurse [RN], who then coordinate weaning of both the ventilator and sedative medications collaboratively. The system also provides real-time insight into the status of patients for both clinicians and ICU administration assessing patient flow. Additionally, it can evaluate for missed opportunities in order to identify operational processes for optimization. A pilot study showed that system reduced significantly time on mechanical ventilation and ICU length of stay. It is now implemented across the UPHS.

Implementation of an automated screening system such as the ABCDE app addresses failures in timing and coordination between care team members and provides data-driven insights into ICU operations that current solutions do not address.

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Stage of Development:

Ready for licensing

Reference Media:

Girard et al. Lancet. 2008, 371 - 12660105-1/abstract)

Balas et al. Crit Care Nurse. 2012, 32 – 15

Benefits

• Automated screening conducted on a continuous basis
• No manual initiation required
• Automatic communication to all care team members
• Reports on historical trends for operational optimization

Applications

• Integration into an EHR with ICU module
• Stand-alone app for use in ICUs
• Coordination of RN and RT in performing ventilator and sedation weaning trials
• Real-time patient status reporting
• Historical reporting to identify missed opportunities