Implementation of Coordinated Spontaneous Awakening and Breathing Trials Using Telehealth-Enabled, Real-Time Audit and Feedback for Clinician AdHerence: A Type II Hybrid Effectiveness-Implementation

使用支持远程医疗的实时审核和临床医生依从性反馈来实施协调的自发觉醒和呼吸试验：II 型混合有效性实施

• 批准号: 10315222
• 负责人: Colin Kerst Grissom
• 金额: $ 61.97万
• 依托单位: IHC HEALTH SERVICES, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10315222
• 关键词: Absence of pain sensation; Acute respiratory failure; Adherence; Adopted; Breathing; COVID-19; Caring; Clinical; Clinical Trials; Clinical effectiveness; Cluster randomized trial; Cognitive; Communication; Communities; Complex; Computerized Medical Record; Consolidated Framework for Implementation Research; Critical Care; Critical Illness; Delirium; Effectiveness; Event; Evidence based practice; Feedback; Goals; Guidelines; Healthcare; Hospitals; Institution; Intensive Care; Intensive Care Units; Interruption; Intervention; Knowledge; Lead; Length of Stay; Lung; Measures; Mechanical Ventilators; Mechanical ventilation; Monitor; Movement; Nurses; Outcome; Oxygen Consumption; Pain; Patient Monitoring; Patient-Focused Outcomes; Patients; Performance; Periodicity; Persons; Physicians; Positioning Attribute; Protocols documentation; Provider; Randomized; Recovery; Research; Respiratory Failure; Risk; Sampling; Sedation procedure; Site; System; Testing; Time; Ventilator; Work; arm; care systems; clinical decision support; dashboard; data sharing; effectiveness implementation study; effectiveness implementation trial; follow-up; implementation strategy; improved; improved outcome; mortality; novel; prospective; provider adherence; remote health care; remote monitoring; respiratory; telehealth; ventilation; ventilator-associated pneumonia

PROJECT SUMMARY Although invasive mechanical ventilation (IMV) is a lifesaving treatment for about 300,000 U.S. patients with acute respiratory failure each year, it is associated with significant risks. Spontaneous awakening and breathing trials during IMV improve patient outcomes. Coordination of spontaneous awakening and breathing trials (C-SAT/SBT) is complex and significant barriers to implementation exist and adherence with C-SAT/SBT across institutions is highly variable. Although national guidelines recommend daily coordinated C-SAT/SBT in IMV patients they are underused. Telehealth-enabled remote care is positioned to improve C-SAT/SBT use. At Intermountain Healthcare, we have system-wide tele-critical care services staffed by critical care physicians, nurses, and respiratory therapists who remotely monitor and assist with patients in ICUs using real-time audiovisual communication, a systemwide electronic medical record (EMR), electronic dashboards, and clinical decision support. We recently studied the impact of implementation strategies to improve evidence-based practices for lung protective ventilation (LPV) in 3 pilot ICUs, and then adopted a Telehealth-Enabled, real-time Audit and feedback for Clinician adHerence (“TEACH”) to disseminate LPV adherence strategies to the other 14 ICUs, achieving over 90% adherence (NCT 03984175). This successful approach could help identify candidates for C-SAT/SBT protocols, prompt bedside providers to perform C-SAT/SBT, and guide execution. The specific aims of this research are to (1) adapt baseline implementation strategies and to target C- SAST/SBT using the Consolidated Framework for Implementation Research; (2) conduct a type II cluster- randomized hybrid effectiveness-implementation trial to compare a usual audit and feedback implementation approach to a usual audit and feedback implementation approach augmented with a Telehealth-Enabled, real- time Audit and feedback for Clinician adHerence (“TEACH”) to promote C-SAT/SBT; and (3) evaluate sustained adherence to the TEACH enhancement in the final year after the RCT has ended. Completion of this project will advance knowledge regarding the effective and sustainable strategies for C- SAT/SBT implementation specifically and the effectiveness generally of telehealth remote monitoring and prompting strategies to aid best practice implementation in ICUs. The proposed research builds on the study team’s existing work and has potential to develop more informed and effective care of persons with respiratory failure. Spread and scale of this telehealth-enabled, central monitoring of critical aspects of care for ICU patients is particularly important to study now, given the vulnerability of ICU staff to COVID-19 exposure.

项目概要 尽管有创机械通气 (IMV) 可以挽救约 300,000 名美国患者的生命 每年发生急性呼吸衰竭，它与自发觉醒和严重的风险相关。 IMV 期间的呼吸试验可改善患者自主觉醒和呼吸的协调。 试验（C-SAT/SBT）很复杂，实施和遵守 C-SAT/SBT 存在重大障碍 尽管国家指南建议每天协调 C-SAT/SBT，但各机构之间的情况差异很大。 IMV 患者未得到充分利用。 在 Intermountain Healthcare，我们支持远程医疗的远程护理旨在改善 C-SAT/SBT 的使用。 拥有由重症监护医生、护士和呼吸系统人员组成的全系统远程重症监护服务 使用实时视听通信远程监控和协助 ICU 患者的治疗师 全系统电子病历 (EMR)、电子仪表板和临床决策支持。 最近研究了战略实​​施对改善肺病循证实践的影响 在 3 个试点 ICU 中实施保护性通气 (LPV)，然后采用远程医疗支持的实时审核和 临床医生依从性 (“TEACH”) 的反馈，以向其他 14 个 ICU 传播 LPV 依从性策略， 实现超过 90% 的依从性 (NCT 03984175)。这种成功的方法可以帮助识别候选人。 C-SAT/SBT 协议，提示床边提供者执行 C-SAT/SBT 并指导执行。 本研究的具体目标是 (1) 调整基线实施策略并瞄准 C- SAST/SBT 使用实施研究综合框架；(2) 开展 II 类集群—— 随机混合有效性实施试验，用于比较通常的审计和反馈实施 常规审计和反馈实施方法的方法，通过远程医疗启用的、实时的 临床医生依从性 (“TEACH”) 的审核和反馈，以促进 C-SAT/SBT；(3) 评估； RCT 结束后的最后一年持续坚持 TEACH 增强。 该项目的完成将增进有关 C- 的有效和可持续战略的知识 SAT/SBT 远程医疗远程监控的具体实施和总体有效性 促进在 ICU 实施最佳实践的策略 拟议的研究以该研究为基础。 团队现有的工作，并有潜力为呼吸系统疾病患者提供更明智、更有效的护理 这种远程医疗支持的对 ICU 护理关键方面的中央监控的传播和规模的失败。 鉴于 ICU 工作人员很容易暴露于 COVID-19，因此现在对患者进行研究尤为重要。