An innovative telemedicine knowledge translation program to improve quality of care in intensive care units: protocol for a cluster randomized pragmatic trial

Damon C Scales,Neill Kj Adhikari,Merrick Zwarenstein,Katie Dainty,Robert A Fowler,Ruxandra Pinto,Brigette Hales

doi:10.1186/1748-5908-4-5

Abstract

BackgroundThere 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.Methods and designWe 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.DiscussionThis 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.Trial RegistrationThis trial is registered with (ID #: NCT00332982)

Highlights

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)
Our objective is to evaluate the effectiveness of a novel knowledge translation program for increasing the proportion of patients who appropriately receive six evidencebased care practices
The network is centred at Sunnybrook Health Sciences Centre, where the medical-surgicaltrauma ICU of this academic hospital will be used as a pilot site for the knowledge translation interventions and data collection approaches

Summary

Introduction

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). Delays between demonstration of effectiveness and the widespread use of such critical care evidence-based 'best practices'[8,9] constitute errors of omission and jeopardize patient outcomes[10,11] These delays in implementation of clinical best practices may be more extreme in non-academic hospitals, with heavier individual clinician workloads and fewer personnel to engage in collaborative continuing educational activities. This general problem is compounded in the province of Ontario, Canada because ICUs are geographically widely separated and no formal quality improvement program exists[12]. Responding to these challenges, the Ministry of Health and Long-term Care sought proposals for development and evaluation of strategies to improve effectiveness of care in Ontario's health care system[13]

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