Implementation of coordinated spontaneous awakening and breathing trials using telehealth-enabled, real-time audit and feedback for clinician adherence (TEACH): a type II hybrid effectiveness-implementation cluster-randomized trial

Implementation Science

Study Protocol

Christopher Jones¹  Lindsay Leither²  Jason R. Jacobs²  Ithan D. Peltan³  Colin K. Grissom⁴  Richard Holubkov⁵  Dee Lisonbee⁶  Bridgett Hanna⁶  Doug Wolfe⁶  Andrew J. Knighton⁶  Rajendu Srivastava⁷  Lori Carpenter⁸  Carrie Winberg⁸ 

[1] Critical Care Operations, Intermountain Health, Canyons Region, Murray, UT, USA;Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 84107, Murray, UT, USA;Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 84107, Murray, UT, USA;Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, UT, USA;Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 84107, Murray, UT, USA;Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, UT, USA;Critical Care Operations, Intermountain Health, Canyons Region, Murray, UT, USA;Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA;Healthcare Delivery Institute, Intermountain Health, Salt Lake City, UT, USA;Healthcare Delivery Institute, Intermountain Health, Salt Lake City, UT, USA;Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA;Respiratory Care, Intermountain Health, Canyons Region, Salt Lake City, UT, USA;

关键词: Mechanical ventilation;    Spontaneous awakening trials;    Spontaneous breathing trials;    Telehealth;    Audit and feedback;    Implementation;    Hybrid effectiveness-implementation trials;   

DOI  :  10.1186/s13012-023-01303-1

 received in 2023-07-27, accepted in 2023-09-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIntensive care unit (ICU) patients on mechanical ventilation often require sedation and analgesia to improve comfort and decrease pain. Prolonged sedation and analgesia, however, may increase time on mechanical ventilation, risk for ventilator associated pneumonia, and delirium. Coordinated interruptions in sedation [spontaneous awakening trials (SATs)] and spontaneous breathing trials (SBTs) increase ventilator-free days and improve mortality. Coordination of SATs and SBTs is difficult with substantial implementation barriers due to difficult-to-execute sequencing between nurses and respiratory therapists. Telehealth-enabled remote care has the potential to overcome these barriers and improve coordinated SAT and SBT adherence by enabling proactive high-risk patient monitoring, surveillance, and real-time assistance to frontline ICU teams.MethodsThe telehealth-enabled, real-time audit and feedback for clinician adherence (TEACH) study will determine whether adding a telehealth augmented real-time audit and feedback to a usual supervisor-led audit and feedback intervention will yield higher coordinated SAT and SBT adherence and more ventilator-free days in mechanically ventilated patients than a usual supervisor-led audit and feedback intervention alone in a type II hybrid effectiveness-implementation cluster-randomized clinical trial in 12 Intermountain Health hospitals with 15 ICUs. In the active comparator control group (six hospitals), the only intervention is the usual supervisor-led audit and feedback implementation. The telehealth-enabled support (TEACH) intervention in six hospitals adds real-time identification of patients eligible for a coordinated SAT and SBT and consultative input from telehealth respiratory therapists, nurses, and physicians to the bedside clinicians to promote adherence including real-time assistance with execution. All intubated and mechanically ventilated patients ≥ 16 years of age are eligible for enrollment except for patients who die on the day of intubation or have preexisting brain death. Based on preliminary power analyses, we plan a 36-month intervention period that includes a 90-day run-in period. Estimated enrollment in the final analysis is up to 9900 mechanically ventilated patients over 33 months.DiscussionThe TEACH study will enhance implementation science by providing insight into how a telehealth intervention augmenting a usual audit and feedback implementation may improve adherence to coordinated SAT and SBT and increase ventilator-free days.Trial registrationClinicaltrials.gov, NCT05141396, registered 12/02/2021.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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