A Multicentre Implementation of a Quality Improvement Initiative to Reduce Delirium in Adult Intensive Care Units: An Interrupted Time Series Analysis
Bibliographic record
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".