(1299) Liberation Bundle in Surgical/Trauma/Transplant ICU: The Story of Success to Prevent Delirium

Introduction: Unfamiliar environments, exposure to anesthetics, pain medications, disturbances in sleep, and drug-induced complications can lead to the beginning of delirium (Ghaeli, et al. 2018). According to the literature, screening for delirium was strongly recommended to be a part of the clinical practice in acute care settings (SCCM, 2021). At the project site, there was no ICU Liberation bundle nor formalized delirium screening protocol in use. Nursing staff used CAM-ICU for delirium screening inconsistently. On average, the length of stay (LOS) in surgical/trauma/transplant ICU was 6.5 days. This project aimed to introduce ICU Liberation Bundle with the implementation of the Society of Critical Care Medicine Intensive Care Delirium Screening Checklist (ICDSC) and evaluate the relationship of its use with the LOS in surgical/trauma/transplant ICU.

Methods: A thorough literature review was conducted, medical director and critical care leaders discussed the need of implementing the ICU Liberation Bundle. Residents and fellows presented the recent research on various delirium screening tools during the weekly journal club. The multidisciplinary team was involved to discuss the appropriateness of SCCM ICDSC use vs CAM-ICU use in surgical/trauma/transplant ICU. The clinical significance of the project was measured by number of days of adult ICU LOS. Intellectus Statistics, 2021 was used for computing the statistical analysis.

Results: Data was collected from the electronic medical record (EMR) and was analyzed for 42 patients (pre-project implementation) and 48 patients (post-implementation) accordingly. The independent t-test result showed a statistically significant reduction in the length of stay of adult patients in the adult intensive care unit (p = 0.021). The LOS stay in the ICU decreased by 4.80 days.

Conclusions: The results of this project show that the delirium screening tool provided a positive impact on the ICU LOS. These results are significant as they provide statistical evidence for the project's overall outcomes. Based on these findings, it is highly recommended to use the ICDSC tool for patients that cannot be screened for delirium with the CAM-ICU tool. Further discussion and additional research will be necessary to evaluate the tool use in other adult ICU specialties.