Non-adherence to ABCDEF bundle as indicator of missed care in the intensive care unit: A retrospective longitudinal study using routine data

Purpose: The study aimed to describe missed care operationalised as ABCDEF bundle non-adherence across the time course of patient stay in the intensive care unit (ICU) using routine data and to investigate the association of missed care with individual patient characteristics. Methods: We conducted a descriptive retrospective longitudinal analysis of the electronic health records of adult patients admitted to an interdisciplinary intensive care unit in a Swiss university hospital. Our main outcome was missed care in selected ABCDEF bundle elements. We used multivariable logistic regression models to investigate the association between individual patient characteristics and missed care in each bundle element. Results: We analysed data from 4704 patients across 12,504 patient days and 26,469 shifts. Overall missed care rate ranged from 5.2% (95%-CI 4.8% to 5.5%) for the C bundle element to 39.1% (95%-CI 36.8% to 41.4%) for the B1 bundle element; with temporal variation across the duration of a patient stay. None of the patient characteristics were consistently linked with higher missed care across the selected bundle elements. Conclusions: The selected ABCDEF bundle elements offer a feasible and promising approach to electronically capture missed care in intensive care units through routine data. Processes and changes can be monitored continuously which can be used as a tool for quality improvement.