Behavioral Economic & Staffing Strategies for Critical Illness
(BEST-ICU Trial)
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Nebraska
Disqualifiers: Chronic ventilation, Prisoners
No Placebo Group
Trial Summary
What is the purpose of this trial?The overarching goal of this study is to support the "real world" assessment of strategies used to foster adoption of several highly efficacious evidence-based practices in healthcare systems that provide care to critically ill adults with known health disparities. Investigators will specifically evaluate two discrete strategies grounded in behavioral economic and implementation science theory (i.e., real-time audit and feedback and registered nurse implementation facilitation) to increase adoption of the ABCDEF bundle in critically ill adults.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Realtime audit and feedback, Real-time audit and feedback, Audit and feedback strategy, RN Implementation Facilitator, Registered Nurse Implementation Facilitator, RN Implementation Facilitator?
Research shows that using audit and feedback strategies can significantly improve the accuracy of medical documentation, such as delirium documentation in intensive care units, by providing tailored feedback to healthcare professionals.
12345Is the audit and feedback strategy safe for humans?
The research does not provide specific safety data for the audit and feedback strategy, but it is generally used to improve healthcare practices and does not involve direct medical interventions, suggesting it is safe for humans.
678910How does the treatment in the 'Behavioral Economic & Staffing Strategies for Critical Illness' trial differ from other treatments for critical illness?
This treatment is unique because it focuses on using audit and feedback strategies to improve healthcare practices in the ICU, rather than relying on traditional medical interventions. It aims to enhance the quality of care by providing healthcare professionals with performance feedback and suggested actions to bridge the gap between intention and behavior.
13111213Eligibility Criteria
This trial is for adults over 19 who are admitted to the ICU, have been on a ventilator there, and stayed at least 24 hours. It's not for patients already on long-term ventilation from home or care facilities, nor prisoners.Inclusion Criteria
I was on a breathing machine in the ICU.
I have stayed in the ICU for at least 24 hours.
I was older than 19 when I was admitted to the ICU.
+1 more
Exclusion Criteria
I am in the hospital and was already on a ventilator before admission.
Prisoners
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Implementation Phase
ICUs receive either real-time audit and feedback or a Registered Nurse implementation facilitator to increase adoption of the ABCDEF bundle
27 months
Follow-up
Implementation and clinical outcomes are collected for an additional 3 months to evaluate the effects of removing the implementation strategies
3 months
Participant Groups
The study tests two strategies in ICUs: real-time audit and feedback plus nurse-led implementation facilitation. The goal is to see if these improve the use of ABCDEF bundle practices among critically ill adults.
3Treatment groups
Experimental Treatment
Active Control
Group I: RN Implementation FacilitatorExperimental Treatment1 Intervention
ICUs receive a extra RN who helps facilitate ABCDEF bundle implementation
Group II: Audit and FeedbackExperimental Treatment1 Intervention
ICUs receive electronic dashboard that displays realtime ABCDEF bundle performance data
Group III: Usual careActive Control1 Intervention
Usual ICU care
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of Iowa Hospitals and ClinicsIowa City, IA
University of Nebraska Medical CenterOmaha, NE
Ohio State UniversityColumbus, OH
Loading ...
Who Is Running the Clinical Trial?
University of NebraskaLead Sponsor
National Heart, Lung, and Blood Institute (NHLBI)Collaborator
Ohio State UniversityCollaborator
University of Wisconsin, MadisonCollaborator
University of IowaCollaborator
References
A qualitative study of the variable effects of audit and feedback in the ICU. [2022]Audit and feedback is integral to performance improvement and behaviour change in the intensive care unit (ICU). However, there remain large gaps in our understanding of the social experience of audit and feedback and the mechanisms whereby it can be optimised as a quality improvement strategy in the ICU setting.
Use of Tailored Feedback Improves Accuracy of Delirium Documentation in the Burn ICU: Results of a Performance Improvement Initiative. [2021]One of the most widely used tools for delirium assessment in burn intensive care units is the Confusion Assessment Method for the Intensive Care Unit delirium assessment tool. However, some nurses struggle with inaccurate delirium documentation. This performance improvement project was undertaken to assess the impact that routine chart audits with tailored feedback would have on documentation accuracy. An a priori goal of at least 90% documentation accuracy was set by burn leadership at our academic, American Burn Association-verified burn center. For the precorrectional feedback time period, nursing delirium documentation was reviewed for accuracy by the nurse educator. In the postcorrectional feedback time period, an intervention was started, in which the educator sent tailored feedback to nurses with inaccurate delirium documentation. A Poisson regression with robust standard errors was used to compare the proportions of correct delirium documentation for the precorrectional feedback and postcorrectional feedback time periods. The overall rates of correct delirium documentation in the precorrectional feedback time period were 49.15% (SD = 31.86), 95% CI: 36.43 to 66.31. A significant increase was seen in the rates of correct delirium documentation for the postcorrectional feedback time period (91.47% [SD = 8.28], 95% CI: 87.45 to 95.67), P = .0001. In the 4 months prior to starting corrective feedback, zero out of five (0%) audits reached the 90% goal of accurate delirium documentation. In the 8 months in which corrective feedback was being given, 9 out of 15 (60%) audits reached the compliance goal set by leadership. Using corrective feedback improves the accuracy of nursing delirium documentation.
Audit and feedback: effects on professional practice and healthcare outcomes. [2022]Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact.
Effect of a multifaceted performance feedback strategy on length of stay compared with benchmark reports alone: a cluster randomized trial in intensive care*. [2013]To assess the impact of applying a multifaceted activating performance feedback strategy on intensive care patient outcomes compared with passively receiving benchmark reports.
Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial. [2019]Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. We combined best practices of audit and feedback with continuously generated electronic health record data to improve performance on quality metrics in an inpatient setting.
A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory. [2023]Audit and feedback is a common intervention for supporting clinical behaviour change. Increasingly, health data are available in electronic format. Yet, little is known regarding if and how electronic audit and feedback (e-A&F) improves quality of care in practice.
[Fifteen ways to optimize feedback.] [2023]This article proposes a series of insights that are drawn from the most up-to-date scientific literature and functional for an optimal implementation of Audit & Feedback (A&F). The focus is on the "feedback" component of the methodology. Some key issues of the feedback are the capability to address changes perceived as priorities for the recipients, recommend actions that bring real improvements, and allow the people to whom recommendations are addressed to manage them. Other suggestions concern how to share the data: it is important to provide feedback as soon as possible, multiple times, starting from individual rather than general data, and including comparisons able to promote the desired change. Other operational indications concern the most effective way to display the feedback, such as tightly linking the graphical representation and the summary message, presenting the feedback in multiple ways, and simplifying the message to minimize cognitive overload. Finally, some suggestions are about how to transmit feedback: tailor interventions according to the specific barriers of a given clinical-organizational context, provide short and easily understandable messages followed by more details, emphasize the credibility of information, increase motivation to change practice, and encourage participatory feedback construction rather than passive delivery. It also proposes an analysis of some of the challenges related to the design of A&F interventions translatable into improvements in practice starting from the context of the Easy-Net network program.
Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol. [2018]Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals' medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback
Improving patient safety incident reporting systems by focusing upon feedback - lessons from English and Welsh trusts. [2022]This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide.
[A&F: obstacles to implementing interventions in the health system.] [2023]Understanding how well a clinician or health care team is performing provides an essential foundation for improvement. If done well, Audit and Feedback (A&F) provides data in non-judgemental, motivating insights and leads to changes in clinical processes that benefit patients. This article will explore obstacles to optimizing the potential positive effects of A&F to improve patient care and outcomes by examining three interrelated steps in the process: the audit; the feedback; and the action. The audit requires data that will be perceived as both valid and actionable. Acquiring and using such data properly often requires partnerships. Feedback recipients need to know how to turn data into action. The A&F, therefore, should include components that direct the recipient toward feasible next steps to undertake the change that will lead to improvement. The proposed actions may be individual (learning new diagnostic or therapeutic strategies, trying a more patient-centered approach, etc.) or organizational (more proactive approaches often including the involvement of additional team members). The ability to turn feedback into action will depend on the culture of the recipient-group, and its level of experience with these change processes. Feedback facilitation or coaching may be useful for some groups or certain kinds of desired changes in practice. Inadequate leadership and support for health professionals, as they try to respond to A&F, is also often a barrier. Finally, with the final focus on the challenges of the individual Work Packages (WP) within the Easy-Net network program, the article focuses on what were the facilitating and hindering factors, the obstacles encountered, and the resistance to change overcome, useful considerations in support of the increasingly widespread implementation of A&F activities in our Healthcare System in the future.
Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial. [2022]Audit and feedback is often used as a strategy to improve quality of care, however, its effects are variable and often marginal. In order to learn how to design and deliver effective feedback, we need to understand their mechanisms of action. This theory-informed study will investigate how electronic audit and feedback affects improvement intentions (i.e. information-intention gap), and whether an action implementation toolbox with suggested actions and materials helps translating those intentions into action (i.e. intention-behaviour gap). The study will be executed in Dutch intensive care units (ICUs) and will be focused on pain management.
Daily weekday audit and feedback to clinicians for an inpatient intervention in obstetrics: is there sustained impact over the weekend? A secondary analysis of a prospective cohort study. [2021]Audit and feedback as an implementation strategy leads to small, but potentially important improvements in practice. Yet, audit and feedback is time and personnel intensive. Many interventions designed for inpatient care are meant to be utilized by care teams all days of the week, including weekends when research staff are at a minimum. We aimed to determine if audit and feedback regarding use of an evidence-based inpatient obstetric intervention performed only on weekdays could have a sustained impact over the weekend.
Facilitating action planning within audit and feedback interventions: a mixed-methods process evaluation of an action implementation toolbox in intensive care. [2021]Audit and feedback (A&F) is more effective if it facilitates action planning, but little is known about how best to do this. We developed an electronic A&F intervention with an action implementation toolbox to improve pain management in intensive care units (ICUs); the toolbox contained suggested actions for improvement. A head-to-head randomised trial demonstrated that the toolbox moderately increased the intervention's effectiveness when compared with A&F only.