Delivery of evidence-based critical care practices across the United Kingdom: A UK-wide multi-site service evaluation in adult units

Background: The ICU Liberation Bundle was developed to improve outcomes for patients admitted to critical care. Despite a lack of Bundle adoption in the UK, the individual evidence-based practices (EBPs) within the bundle are defined as standards of care by the UK Intensive Care Society. There are limited data on the delivery of these EBPs.

Objective: To evaluate current delivery of the EBPs of the ICU Liberation bundle in a sample of hospitals in the UK National Health Service (NHS) presenting delivery of EBP's between hospitals, their stability of delivery across multiple weeks and in comparison to US hospitals in the original ICU Liberation Bundle study.

Methods: Multi-centre service evaluation, using modified definitions of compliance from the ICU Liberation Bundle study. We sampled six representative units from across the UK; data collection totalled 1116 patient days. Data were analysed using descriptive statistics.

Results: Across all six units, patients received a median of 42.9% (IQR 40%-60%) of all possible bundle EBPs. Unit bundle proportional compliance (number of components completed/eligible number of components) ranged from 40.0% (IQR 28.6%-50.0%) to 71.4% (IQR 57.1%-80.0%). Units completed spontaneous awakening trials most regularly in 80.1% of eligible patients (149/186). Delirium assessments were the least adhered to EBP with only 32.2% (359/1116) of patients receiving at least two validated delirium assessments per day. Full bundle compliance was lower in the UK cohort in comparison to the original trial (4% vs 8%).

Discussion: We identified substantial variation in the delivery of seven evidence-based practices that are considered standards of care in the UK. Variation existed between hospitals and within each hospital over time. These data begin to describe the current state of EBP adherence in a selection of critical care units.