Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada.
Implement Sci. 2009 Feb 16;4:5. doi: 10.1186/1748-5908-4-5.
There are challenges to timely adoption of, and ongoing adherence to, evidence-based practices known to improve patient care in the intensive care unit (ICU). Quality improvement initiatives using a collaborative network approach may increase the use of such practices. Our objective is to evaluate the effectiveness of a novel knowledge translation program for increasing the proportion of patients who appropriately receive the following six evidence-based care practices: venous thromboembolism prophylaxis; ventilator-associated pneumonia prevention; spontaneous breathing trials; catheter-related bloodstream infection prevention; decubitus ulcer prevention; and early enteral nutrition.
We will conduct a pragmatic cluster randomized active control trial in 15 community ICUs and one academic ICU in Ontario, Canada. The intervention is a multifaceted videoconferenced educational and problem-solving forum to organize knowledge translation strategies, including comparative audit and feedback, educational sessions from content experts, and dissemination of algorithms. Fifteen individual ICUs (clusters) will be randomized to receive quality improvement interventions targeting one of the best practices during each of six study phases. Each phase lasts four months during the first study year and three months during the second. At the end of each study phase, ICUs are assigned to an intervention for a best practice not yet received according to a random schedule. The primary analysis will use patient-level process-of-care data to measure the intervention's effect on rates of adoption and adherence of each best practice in the targeted ICU clusters versus controls.
This study design evaluates a new system for knowledge translation and quality improvement across six common ICU problems. All participating ICUs receive quality improvement initiatives during every study phase, improving buy-in. This study design could be considered for other quality improvement interventions and in other care settings.
在重症监护病房（ICU）中，及时采用和持续遵循已知能改善患者护理的循证实践存在挑战。使用协作网络方法的质量改进举措可能会增加这些实践的应用。我们的目标是评估一种新的知识转化计划在增加以下六项循证护理实践中适当接受患者比例的有效性：静脉血栓栓塞预防；呼吸机相关性肺炎预防；自主呼吸试验；导管相关血流感染预防；压疮预防；以及早期肠内营养。
我们将在加拿大安大略省的 15 家社区 ICU 和一家学术 ICU 中进行一项实用的群组随机对照活性对照试验。干预措施是一个多方面的视频会议教育和解决问题的论坛，旨在组织知识转化策略，包括比较审计和反馈、来自内容专家的教育课程以及算法的传播。15 个单独的 ICU（群组）将随机分配到针对六个研究阶段中每个阶段的最佳实践之一的质量改进干预措施中。每个阶段在第一年的研究中持续四个月，第二年的研究中持续三个月。在每个研究阶段结束时，根据随机时间表，将 ICU 分配到尚未接受最佳实践的干预措施中。主要分析将使用患者层面的护理过程数据来衡量干预措施对目标 ICU 群组中每种最佳实践的采用率和遵守率的影响。
这项研究设计评估了一种针对六个常见 ICU 问题的新的知识转化和质量改进系统。所有参与的 ICU 在每个研究阶段都接受质量改进举措，提高了参与度。这种研究设计可以考虑用于其他质量改进干预措施和其他护理环境中。
