Figure 1.

Association between proportional performance of the ABCDEF bundle and patient-related outcomes. Each panel shows the adjusted hazard ratio and 95% CI for the specified outcome, comparing patients with a given proportion of eligible ABCDEF bundle elements performed on a given day with patients with none of the bundle elements performed that day. The gray line at 1.0 indicates no association. Hazard ratios are adjusted for baseline, ICU admission characteristics, and daily covariates, measured the same day as bundle performance. For example, assuming all other covariates are equal, a patient who had 60% of the ABCDEF bundle elements for which he/she was eligible has on average about 1.4 times the likelihood of being discharged from the ICU on a given day as a patient with none of the bundle elements performed. All three outcomes were significant (p < 0.0001). The covariates adjusted for include demographic variables (age, sex, race, ethnicity, body mass index, residence before admission, mobility restriction before admission), admission features (diagnosis, hospital type [community vs. teaching], and ICU type), and daily ICU characteristics on the day of bundle exposure (receipt of medications, including benzodiazepines, opioids, propofol, dexmedetomidine, typical/atypical antipsychotics; comfort care order; mechanical ventilation; coma). We also adjusted for delirium on the day of bundle exposure when looking at the association between the bundle and delirium. Patients were “eligible to receive” elements A, C, D, and E on all ICU days. Patients were eligible for element B if sedated (part 1, SAT) and/or mechanically ventilated (part 2, SBT), and were eligible for element F if family or another caregiver was present. Therefore, patients were eligible for a maximum of seven and a minimum of four elements on any given day; proportion of elements performed is the number of elements performed, divided by the elements the patient was eligible to receive.