First Author: Briana Miller, DNP, FNP-C, AGACNP-BC, RNFA, CSSBB – Wake Forest University School of Medicine Co-Author: Jessica Palakshappa, MD, MS – Associate Professor, Atrium Health Wake Forest Baptist Co-Author: Jevonnie Barrett, MBA-HCM, BSRT, RRT – Adult Manager, Respiratory Care, Wake Forest Baptist Health Co-Author: Andrew Nunn, MD – Academic Faculty, Physician, Wake Forest Baptist Medical Center Co-Author: Tina Lovings, MHS, RRT-ACCS – Director Respiratory Care, Wake Forest Baptist Health Co-Author: Bethany Webster, RN, MSN – Critical Care Nurse Educator, Atrium Health Wake Forest Baptist Health Co-Author: Kimberly Ann Maye, RN – Nurse Manager, Atrium Health Wake Forest Baptist Co-Author: Michelle Mitchell, RRT – Supervisor, Respiratory Care, Atrium Health Wake Forest Baptist Co-Author: Andrea Burnie, RRT – Supervisor, Respiratory Care, Atrium Health Wake Forest Baptist Co-Author: Amy Greene, MHL, BSN, RN, CPHQ – Outcomes Specialist, Quality Management, Atrium Health Co-Author: Chris Russell, MD – Assistant Specialty Medical Director, Atrium Health Co-Author: Peter Miller, MD – Academic Faculty, Physician, Wake Forest University School of Medicine Co-Author: Travis Dotson, MD – Academic Faculty, Physician, Wake Forest Baptist Medical Center
Introduction: Coordinated Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT) are an important component of the SCCM's ICU Liberation (ABCDEF) Bundle, a collection of best practices that reduce harmful effects of ICU stays and improve patient outcomes in critically ill patients. SATs & SBTs liberate patients from excess sedation and mechanical ventilation (MV). This quality improvement project describes a multidisciplinary initiative at a large academic medical center to (1) improve performance of SAT and SBT processes & (2) reduce mechanical ventilation days through enhancing knowledge, communication, and protocol adherence.
Methods: A multidisciplinary group coordinated efforts across 7 ICUs over several PDSA cycles. Respiratory therapists (RT) piloted SBT data forms to identify gaps between task completion and EMR data and RNs completed a survey to assess knowledge, practice, and communication gaps. RN education focused on ABCDEF bundle and knowledge gaps identified in the survey. RT education emphasized communication with the team and documentation. The "Awake by 8" SAT Campaign promoted expectations for SAT completion time. Team communication was emphasized at multiple stages in the process as applicable for each patient: reason for failing a safety screen or a trial and ensuring a plan is in place post-SAT/SBT completion. Team feedback supported documentation and data requests for ABCDEF work across the healthcare system.
Results: More than 80% of RN and RT teammates completed education. Baseline (Q2 2024) and post-intervention (Q2 2025) SAT/SBT data show sustained or improved outcomes in all areas except SAT Completion, which dipped slightly from 84.6% to 83.2%. This may be representative of better capture through screening processes. Improvements were seen in SAT Safety Screen (7.6% to 19.2%), SBT Screening (39.8% to 66.2%), and SBT Performance (67.1% to 73.8%). Baseline MV Days (Apr-Dec 2024) improved from 3.55 to 3.09 YTD in 2025 (May), averaging ~11 hours saved per patient.
Conclusions: Spontaneous Awakening and Breathing trials are complex and nuanced, requiring careful coordination and ongoing quality improvement. Addressing these complexities with a multidisciplinary team and a variety of strategies will help to drive improvements to improve patient outcomes.
