{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T01:09:40Z","timestamp":1770944980442,"version":"3.50.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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 a lack of standardized data elements hinder effective implementation and evaluation of adherence to bundle components.<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>We conducted a retrospective analysis of data elements related to the A-F bundle using the MIMIC-IV database. Clinical concepts were mapped to standardized vocabularies and aligned with the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Bundle cards were developed for each component to provide structured, accessible documentation of assessment tools, adherence criteria, and terminology mappings.<\/jats:p>\n                  <jats:p>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 the Society of Critical Care Medicine (SCCM) adherence criteria. Delirium assessments followed standardized protocols incorporating Richmond Agitation-Sedation Scale (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.<\/jats:p>\n                  <jats:p>We developed and validated six ICU Liberation Bundle cards that map bundle components to standardized vocabularies and CDMs, 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.<\/jats:p>","DOI":"10.1055\/a-2802-7458","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T23:56:09Z","timestamp":1770162969000},"page":"052-059","source":"Crossref","is-referenced-by-count":0,"title":["Standardizing Data Elements for Implementation of ICU Liberation Bundle"],"prefix":"10.1055","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0524-4587","authenticated-orcid":false,"given":"Md Fantacher","family":"Islam","sequence":"additional","affiliation":[{"name":"College of Engineering, The University of Arizona, Tucson, Arizona, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Douglas","sequence":"additional","affiliation":[{"name":"College of Medicine - Tucson, The University of Arizona, Tucson, Arizona, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarrod","family":"Mosier","sequence":"additional","affiliation":[{"name":"College of Medicine - Tucson, The University of Arizona, Tucson, Arizona, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vignesh","family":"Subbian","sequence":"additional","affiliation":[{"name":"College of Engineering, The University of Arizona, Tucson, Arizona, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s13012-015-0306-1","article-title":"What are effective strategies for the implementation of care bundles on ICUs?: A systematic review","volume":"10","author":"M J Borgert","year":"2015","journal-title":"Implement Sci"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/bcp.16031","article-title":"The risk of delirium after sedation with propofol or midazolam in intensive care unit patients","volume":"90","author":"T G van Gelder","year":"2024","journal-title":"Br J Clin Pharmacol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13054-015-0886-9","article-title":"A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes","volume":"19","author":"Z Trogrli\u0107","year":"2015","journal-title":"Crit Care"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"e070962","DOI":"10.1136\/bmjopen-2022-070962","article-title":"Effect of ICU care bundles on long-term patient-relevant outcomes: A scoping review","volume":"13","author":"N Paul","year":"2023","journal-title":"BMJ Open"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1097\/CCM.0000000000001856","article-title":"ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research","volume":"44","author":"J L Nates","year":"2016","journal-title":"Crit Care Med"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ccc.2016.12.005","article-title":"The ABCDEF Bundle in critical care","volume":"33","author":"A Marra","year":"2017","journal-title":"Crit Care Clin"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1055\/a-2036-0337","article-title":"Improving pediatric intensive care unit discharge timeliness of infants with bronchiolitis using clinical decision support","volume":"14","author":"B Martin","year":"2023","journal-title":"Appl Clin Inform"},{"issue":"03","key":"ref8","first-page":"e0872","article-title":"An exploration of critical care professionals' strategies to enhance daily implementation of the assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesia and sedation; delirium assess, prevent, and manage; early mobility and exercise; and family engagement and empowerment: A group concept mapping study","volume":"5","author":"L C Mion","year":"2023","journal-title":"Crit Care Explor"},{"key":"ref10","volume-title":"ICU Liberation Bundle: Nursing Attitudes and Potential Barriers to Implementation [MS dissertation]","author":"A Hobbins","year":"2023"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40124-020-00216-7","article-title":"The ICU Liberation Bundle and strategies for implementation in pediatrics","volume":"8","author":"A Walz","year":"2020","journal-title":"Curr Pediatr Rep"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"e1111","DOI":"10.1097\/CCM.0000000000002640","article-title":"Worldwide survey of the \u201cAssessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring\/Management, Early Exercise\/Mobility, and Family Empowerment\u201d (ABCDEF) Bundle","volume":"45","author":"A Morandi","year":"2017","journal-title":"Crit Care Med"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1177\/08850666231220558","article-title":"Barriers to implementing the ICU Liberation Bundle in a single-center pediatric and cardiac ICUs","volume":"39","author":"A McCudden","year":"2023","journal-title":"J Intensive Care Med"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1055\/s-0039-1697598","article-title":"Incrementally transforming electronic medical records into the observational medical outcomes partnership common data model: A multidimensional quality assurance approach","volume":"10","author":"K E Lynch","year":"2019","journal-title":"Appl Clin Inform"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"e100953","DOI":"10.1136\/bmjhci-2023-100953","article-title":"Seamless EMR data access: Integrated governance, digital health and the OMOP-CDM","volume":"31","author":"C M Hallinan","year":"2024","journal-title":"BMJ Health Care Inform"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1093\/jamia\/ocae102","article-title":"Nutrition facts, drug facts, and model facts: putting AI ethics into practice in gun violence research","volume":"31","author":"J Zhu","year":"2024","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset","volume":"10","author":"A EW Johnson","year":"2023","journal-title":"Sci Data"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jcrc.2009.08.005","article-title":"Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients","volume":"25","author":"U Guenther","year":"2010","journal-title":"J Crit Care"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1002\/nop2.287","article-title":"Families of patients in ICU: A scoping review of their needs and satisfaction with care","volume":"6","author":"P Scott","year":"2019","journal-title":"Nurs Open"},{"issue":"25","key":"ref24","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1056\/NEJMoa1802637","article-title":"A randomized trial of a family-support intervention in intensive care units","volume":"378","author":"D B White","year":"2018","journal-title":"N Engl J Med"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1055\/a-2165-5861","article-title":"The Intensive Care Unit Bundle Board: A novel real-time data visualization tool to improve maintenance care for invasive catheters","volume":"14","author":"C L Davis","year":"2023","journal-title":"Appl Clin Inform"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2802-7458.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:20:55Z","timestamp":1770942055000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2802-7458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":20,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,22]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2802-7458","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2,3]]},"published":{"date-parts":[[2026,1]]}}}