Go Forth and Liberate: A Coordinated Multicenter Approach to ABCDEF Bundle Implementation

Introduction: The ICU Liberation (A-F) Bundle is a collection of best practices that improve outcomes & and reduce harm in the ICU. In early 2024, a cross-facility strategy was organized to reinvigorate ICU Liberation efforts. This project focuses on the collaborative work at 16 ICUs at 11 facilities in NC from May 2024 through June 2025. Each Bundle element received individual attention, with particular focus on Spontaneous Awakening and Spontaneous Breathing Trial (SAT & SBT) processes, aiming to reduce mechanical ventilator (MV) days.


Methods: Key stakeholders across were engaged. An interdisciplinary committee began meeting monthly in May 2024 focused on educational needs, meaningful data (dashboard build & optimization), EMR enhancements, protocol socialization, & sharing of best practices & resources. Leadership buy-in has been strong throughout the process, with a strong engagement from clinical sites.
Education was provided to all new ICU RN hires. Grand Rounds focused on ICU Liberation. Resources were developed & shared. Sessions were held to onboard leaders to the dashboard & data reporting. In Q1, 2025, additional sessions were conducted with committee & site leadership for action planning. The "Awake by 8, Breathing by Brunch" campaign focused on timely and routine SAT & SBTs. EMR enhancements improved clinician workflows and data capture.


Results: Baseline data (Q1 2024) are compared here to most recent quarter (Q2 2025). Compliance improved in all areas of Bundle performance, specifically SAT Assessment (23.05% to 34.95%), & SAT Performance (80.69% to 82.13%). SBT Assessment (85.3% to 94.4%) & SBT Performance (64.8% to 86.5%) also increased. Due to increased capture, the number of SATs performed nearly doubled from 485 to 947 in the reported quarters.
RASS Scoring (element C) remained strong (96.97% to 97.92%). Bundle performance also improved in: Pain Assessments (61.09% to 64.30%), Delirium assessments (56.19% to 67.08%), Early Mobility Safety Screen (3.1% to 31.2%) & performance (51.5% to 60%).
Baseline average duration of MV was 4.022 (Q1 2024), with YTD 2025 of 3.63 (Jan-Jun).


Conclusions: A structured approach with data and performance feedback, strong leadership support, and shared resources, improves adherence across all Bundle elements with favorable improvements in duration of MV.