Standardizing Data Elements for Implementation of ICU Liberation Bundle

Background and Significance: Getting patients out of intensive care units (ICUs) is a major goal for acute care clinicians, as prolonged stays increase the risk of complications and strain critical resources such as staff, equipment, and beds. The ICU Liberation bundle or the ABCDEF (A-F) care bundle is an evidence-based framework for improving outcomes in critically ill patients by addressing pain, sedation, delirium, mobility, and family engagement. However, variability in documentation and lack of standardized data elements hinder effective implementation and evaluation of adherence to bundle components. Objectives: This study aims to characterize data elements of the A-F liberation bundle using a large, single-center critical care database and to develop standardized bundle cards that map bundle components to controlled vocabularies. Methods: We conducted a retrospective analysis of data elements related to A-F bundle using the MIMIC-IV database. Clinical concepts were mapped to standardized vocabularies and aligned with the OMOP common data model. Bundle cards were developed for each component to provide structured, accessible documentation of assessment tools, adherence criteria, and terminology mappings. Results: Pain assessments were documented in over 11,000 patients, with a median of 23 assessments per day. Sedation levels for nearly 59,000 patients were evaluated, with 37.7% meeting Society of Critical Care Medicine (SCCM) adherence criteria. Delirium assessments followed standardized protocols incorporating RASS and CAM-ICU scores. Components E and F lacked formal compliance specifications; bundle cards for these components identified key activities and highlighted gaps in standardized vocabularies. Adherence analyses revealed variability likely due to non-standardized documentation practices. Conclusion: We developed and validated six ICU Liberation Bundle cards that map bundle components to standardized vocabularies and common data models, enabling retrospective adherence evaluation in real-world data. These information resources promote consistent documentation, support interoperability, and provide a foundation for prospective monitoring to enhance bundle implementation in critical care.