Successful Implementation of the ICU Liberation Bundle in a Florida Community Hospital

Implementing the ICU Liberation Bundle (A-F) has fundamentally changed outcomes for our patients at BayCare Winter Haven Hospital in Winter Haven, Florida, USA. Through daily, consistent application of the bundle elements, our team has achieved measurable success, including faster liberation from mechanical ventilation, shorter intensive care unit (ICU) stays, and a meaningful reduction in mortality among our critically ill population.

Our medical-surgical ICU is one of the highest-acuity ICUs in the BayCare Health System, which operates 16 hospitals across Florida. In 2020, our team committed to implementing the ICU Liberation Bundle to reduce the physical, cognitive, and emotional burdens of critical illness.

Quality improvement is typically more challenging in community hospitals, which have many potential barriers to establishing new processes. We quickly discovered that translating evidence-based practices into daily workflows presents unique challenges. Limited resources, competing priorities, and the disruption of the COVID-19 pandemic tested our persistence.

The first multiprofessional group who initiated the ICU liberation process comprised the ICU medical director, the critical care nurse manager, and the respiratory therapy manager. The team reviewed all available implementation resources and education materials provided by the ICU Liberation Campaign and started with revising Winter Haven Hospital’s multidisciplinary critical care rounding tool to fully incorporate the bundle’s A-F components.

A comprehensive educational initiative followed, targeting all care team members involved in rounds, including intensivists, advanced practice clinicians, critical care nurses, respiratory therapists, physical therapists, pharmacists, dietitians, infection prevention staff, palliative care professionals, case management staff, and the spiritual care team.

This coordinated approach received overwhelmingly positive feedback. Team members immediately recognized the value of using the ICU Liberation Bundle to support the recovery of critically ill patients and their families. Our main buy-in occurred when rounds became more structured, efficient, and patient-centered, enhancing communication and care planning across disciplines.

The most profound benefits of the ICU Liberation Bundle occur when all elements are applied together as a unified standard of care. To maintain momentum and ensure long-term success, we embedded ICU Liberation education into our ongoing staff development initiatives. Our hospital’s nursing performance development team launched a systemwide ICU Liberation Workshop—hands-on, in-person training for all critical care nurses across the BayCare Health System. Leadership support was essential in making this education mandatory. We are on track to achieve 100% participation among critical care nurses by the end of 2025.

We also developed a multidisciplinary team of superusers—nurses, educators, respiratory therapists, and physical therapists—who serve as frontline champions. They provide real-time education, model bundle practices during daily rounds, and mentor newer staff. This peer-driven approach has been key to sustaining engagement and standardizing practice.

Since the implementation of the ICU Liberation Campaign, our institution has continued to actively measure patient outcome indicators and ICU metrics. From the first quarter of 2023 through the first quarter of 2025, implementation of the bundle had a significant positive impact on key ICU metrics: ICU length of stay ratio decreased 22%, average ventilator days decreased 38%, and ICU mortality ratio decreased 48%. Consistently using the bundle every day for every single ICU patient (medical, surgical, neurologic, cardiac) during multidisciplinary critical care rounds allowed us to ensure success.

The experience of implementing the ICU Liberation Campaign at our community hospital shows that a non-academic center can achieve performance of this comprehensive bundle program. Forming a coalition of healthcare professionals with a clear mission is the first step to successful implementation. Through collaboration, education, and consistency, we transformed implementation challenges into opportunities and built a sustainable, systemwide model for ICU liberation that continues to improve outcomes today.