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.
Age > or = to 19 years at time of ICU admission
Received invasive mechanical ventilation while in a cluster ICU
Admitted to participating cluster ICU
Cluster ICU length of stay of at least 24 hours
Patient who is admitted to the hospital who is already receiving chronic long-term mechanical ventilation from the home, assisted living, or long-term care setting
Prisoners
Parallel
Realtime audit and feedback
BehavioralICUs randomized to this arm will receive and electronic dashboard that displays realtime ABCDEF bundle performance data
RN Implementation Facilitator
BehavioralICUs randomized to this arm will receive a RN who will assist with ABCDEF bundle implementation
Proportional ABCDEF bundle performance
Defined as the percentage of eligible elements a patient receives on a given ICU day \["bundle dose"\].
Complete ABCDEF bundle performance
Defined as a patient day in which every eligible element of the bundle was performed (i.e., 100% of the bundle versus anything less; yes/no).
Duration of invasive mechanical ventilation
Days spent in ICU on invasive mechanical ventilation
Number of participants with new tracheotomy placement
Current Procedural Terminology code for tracheotomy during hospitalization
advanced noninvasive respiratory therapy use and duration
The recorded timestamps for advanced non-invasive respiratory therapy using CPAP, BiLevel Positive Pressure Ventilation (BiPaP), or high flow cannula with oxygen flow rates \>20 lpm using a face mask or other airway that is NOT an endotracheal tube will be monitored. Specific data elements in the EHR relevant to advanced non-invasive respiratory therapy will be examined. This may include. * Clinical orders for the initiation of BiPaP * Respiratory therapy logs of pressure setting management * Ventilator settings and parameters recorded over time. Once the data is organized, the duration of advanced non-invasive respiratory therapy for each patient will be calculated using the following formula: Duration (in hours) = CPAP/BiPaP/High Flow Oxygen Initiation Time - CPAP/BiPaP/High Flow OxygenTermination Time
Number of participants with an ICU mortality
A death event that is recorded in the electronic health record (EHR) that occurred after index ICU admission and prior to the index ICU discharge date and time
Number of participants with a hospital mortality
A death event that is recorded in the EHR that occurred after index ICU admission and prior to discharge from the hospital on the index hospital stay.
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University of Nebraska
Lead sponsor
Ohio State University
Collaborator
University of Iowa
Collaborator
University of Wisconsin, Madison
Collaborator
National Heart, Lung, and Blood Institute (NHLBI)
Collaborator
