Acute Respiratory Failure
Conditions
Keywords
Noninvasive ventilation, Education, Intensive care unit, Mechanical ventilation, Evidence-based practice
Brief summary
This study will pilot test three strategies designed to speed implementation of preventive post-extubation noninvasive ventilation (NIV): one control strategy (traditional online continuing medical education) and two novel strategies (interprofessional education and just-in-time education).
Detailed description
During a one-month intervention period, the investigators will pilot test the educational strategies in three participating UPMC ICUs. Prior to receiving education, participants will be invited to complete a short online survey. Participants in the control group will be invited to complete a 30-minute online continuing education module, which will conclude with a survey. Participants in the interprofessional education group will be invited to attend a 90-minute, in-person, interprofessional education session that will occur in or near the participating ICU. A trained advance practice provider will provide participants in the just-in-time education group with 5-10 minutes of education in the ICU when the ICU team is rounding on a patient who is identified to be high risk for extubation failure. The just-in-time education may occur more than once per day, depending on the number of high-risk patients identified. All educational strategies will include content on the benefits of preventive post-extubation NIV, the indications and contraindications for preventive post-extubation NIV, and the value of working together as an interprofessional ICU team when implementing preventive post-extubation NIV. Each educational intervention will include a survey designed to determine the feasibility, acceptability, and preliminary impact of the educational strategies. The investigators will also directly observe instances of interprofessional and just-in-time education and conduct in-person interviews to assess these factors in a qualitative manner. Lastly, during the intervention period and the 6 months before and after the intervention period, the investigators will collect data from the electronic health record and analyze changes in percent of high-risk patients who receive preventive post-extubation NIV, reintubation rate, duration of mechanical ventilation, ventilator-associated pneumonia, and in-hospital mortality.
Interventions
BEHAVIORALTraditional online continuing education
30-minute, online, interactive, educational video describing the benefits of preventive post-extubation NIV, the indications and contraindications for preventive post-extubation NIV, and the value of working together as an interprofessional ICU team when implementing preventive post-extubation NIV
BEHAVIORALInterprofessional education
One-time, 90-120-minute, in-person, interprofessional educational workshop consisting of a 30-minute didactic session and a 60-90-minute small group session
BEHAVIORALJust-in-time education
Just-in-time, point-of-care education provided by trained advanced practice providers who will be on-hand in the study ICU, where they will deliver the education at the bedside during rounds when a patient meets criteria for preventive post-extubation NIV
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
University of Pittsburgh
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Two study populations will be included. Learners (population 1) will include: * frontline care providers, including physicians, advanced practice providers, nurses, and respiratory therapists * working in a participating ICU. Frontline care providers will be excluded if they: * have not worked in their current UPMC ICU for more than one month prior to the current study * have not directly cared for a mechanically ventilated patient in a UPMC ICU during the three months preceding the current study. Patients (population 2) will include: * mechanically ventilated patients * treated in the participating ICUs * surviving to extubation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of ICU Team Members (Learners) Who Received Education | Up to 1 month | This implementation outcome measuring reach only applies to learner participants. |
| Learner Attitudes Regarding Education (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement I liked the way the information was presented. This outcome only applies to learner participants. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Learner Specialization (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In assessing mechanically ventilated patients for potential extubation, I have knowledge that no other team member has. This outcome only applies to learner participants. |
| Learner Credibility (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In making decisions about extubation, I am comfortable accepting procedural suggestions from other team members. This outcome only applies to learner participants. |
| Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | Participants will be followed for the duration of their hospital admission, estimated to be 1-2 weeks | This implementation outcome only applies to patient participants. |
| Learner Psychological Safety (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement I'm confident that when I make suggestions, other members of the care team will listen. This outcome only applies to learner participants. |
| Learner Perspectives on Leader Inclusiveness (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement From now on, physicians in this ICU are likely to strike an appropriate balance between authority and openness to suggestion. This outcome only applies to learner participants. |
| Learner Coordination (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In delivering care to patients in respiratory failure, our ICU team works together in a well-coordinated fashion. This outcome only applies to learner participants. |
| Learner Role Clarity (Mean Scores on Relevant Survey Questions) | Up to 10 weeks | Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In assessing mechanically ventilated patients for potential extubation, I know what my responsibilities are. This outcome only applies to learner participants. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Traditional Online Continuing Education Group - Pre-education Patients admitted during the 6 months prior to the education period to the ICU that would later participate in traditional online continuing education. | 116 |
| Traditional Online Continuing Education Group - During Education Patients admitted during the one-month education period to the ICU that participated in traditional online continuing education. | 28 |
| Traditional Online Continuing Education Group - Post-education Patients admitted during the 6 months after the education period to the ICU that participated in traditional online continuing education. | 146 |
| Interprofessional Education Group - Pre-education Patients admitted during the 6 months prior to the education period to the ICU that would later participate in interprofessional education. | 188 |
| Interprofessional Education - During Education Patients admitted during the one-month education period to the ICU that participated in interprofessional education. | 24 |
| Interprofessional Education Group - Post-education Patients admitted during the 6 months after the education period to the ICU that participated in interprofessional education. | 183 |
| Just-in-time Education - Pre-education Patients admitted during the 6 months prior to the education period to the ICU that would later participate in just-in-time education. | 275 |
| Just-in-time Education Group - During Education Patients admitted during the one-month education period to the ICU that participated in just-in-time education. | 27 |
| Just-in-time Education Group - Post-education Patients admitted during the 6 months after the education period to the ICU that participated in just-in-time education. | 276 |
| Traditional Online Continuing Education Group - Learners Learners who participated in traditional online continuing education | 22 |
| Interprofessional Education Group - Learners Learners who participated in interprofessional education | 31 |
| Just-in-time Education Group - Learners Learners who participated in just-in-time education | 12 |
| Total | 1,328 |
Baseline characteristics
| Characteristic | Traditional Online Continuing Education Group - During Education | Traditional Online Continuing Education Group - Post-education | Interprofessional Education Group - Pre-education | Interprofessional Education - During Education | Interprofessional Education Group - Post-education | Traditional Online Continuing Education Group - Pre-education | Just-in-time Education - Pre-education | Just-in-time Education Group - During Education | Just-in-time Education Group - Post-education | Total |
|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | 79 years | 74 years | 74 years | 77 years | 75 years | 72 years | 70 years | 69 years | 71 years | 73 years |
| Race/Ethnicity, Customized Race Black | 2 Participants | 20 Participants | 6 Participants | 0 Participants | 7 Participants | 10 Participants | 20 Participants | 4 Participants | 56 Participants | 125 Participants |
| Race/Ethnicity, Customized Race Other | 3 Participants | 6 Participants | 5 Participants | 1 Participants | 6 Participants | 10 Participants | 19 Participants | 2 Participants | 34 Participants | 86 Participants |
| Race/Ethnicity, Customized Race White | 23 Participants | 120 Participants | 177 Participants | 23 Participants | 170 Participants | 96 Participants | 236 Participants | 21 Participants | 186 Participants | 1052 Participants |
| Sequential Organ Failure Assessment (SOFA) Score | 7 units on a scale | 7 units on a scale | 8 units on a scale | 9 units on a scale | 8 units on a scale | 9 units on a scale | 7 units on a scale | 10 units on a scale | 5 units on a scale | 7 units on a scale |
| Sex: Female, Male Female | 20 Participants | 71 Participants | 85 Participants | 10 Participants | 100 Participants | 52 Participants | 165 Participants | 7 Participants | 87 Participants | 597 Participants |
| Sex: Female, Male Male | 8 Participants | 75 Participants | 103 Participants | 14 Participants | 83 Participants | 64 Participants | 110 Participants | 20 Participants | 189 Participants | 666 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk | EG009 affected / at risk | EG010 affected / at risk | EG011 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 44 / 116 | 10 / 28 | 61 / 146 | 37 / 188 | 8 / 24 | 58 / 183 | 130 / 275 | 5 / 27 | 57 / 276 | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 116 | 0 / 28 | 0 / 146 | 0 / 188 | 0 / 24 | 0 / 183 | 0 / 275 | 0 / 27 | 0 / 276 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 116 | 0 / 28 | 0 / 146 | 0 / 188 | 0 / 24 | 0 / 183 | 0 / 275 | 0 / 27 | 0 / 276 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Learner Attitudes Regarding Education (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement I liked the way the information was presented. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Attitudes Regarding Education (Mean Scores on Relevant Survey Questions) | 4.2 score on a scale | Standard Deviation 0.7 |
| Interprofessional Education Group - Learners | Learner Attitudes Regarding Education (Mean Scores on Relevant Survey Questions) | 4.8 score on a scale | Standard Deviation 0.6 |
| Just-in-time Education Group - Learners | Learner Attitudes Regarding Education (Mean Scores on Relevant Survey Questions) | 3.4 score on a scale | Standard Deviation 1 |
Primary
Number of ICU Team Members (Learners) Who Received Education
This implementation outcome measuring reach only applies to learner participants.
Time frame: Up to 1 month
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Traditional Online Continuing Education Group - Learners | Number of ICU Team Members (Learners) Who Received Education | 22 Participants |
| Interprofessional Education Group - Learners | Number of ICU Team Members (Learners) Who Received Education | 31 Participants |
| Just-in-time Education Group - Learners | Number of ICU Team Members (Learners) Who Received Education | 12 Participants |
Secondary
Learner Coordination (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In delivering care to patients in respiratory failure, our ICU team works together in a well-coordinated fashion. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Coordination (Mean Scores on Relevant Survey Questions) | 4.3 score on a scale | Standard Deviation 0.7 |
| Interprofessional Education Group - Learners | Learner Coordination (Mean Scores on Relevant Survey Questions) | 4.9 score on a scale | Standard Deviation 0.3 |
| Just-in-time Education Group - Learners | Learner Coordination (Mean Scores on Relevant Survey Questions) | 4.3 score on a scale | Standard Deviation 0.9 |
Secondary
Learner Credibility (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In making decisions about extubation, I am comfortable accepting procedural suggestions from other team members. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Credibility (Mean Scores on Relevant Survey Questions) | 4.5 score on a scale | Standard Deviation 0.7 |
| Interprofessional Education Group - Learners | Learner Credibility (Mean Scores on Relevant Survey Questions) | 4.9 score on a scale | Standard Deviation 0.3 |
| Just-in-time Education Group - Learners | Learner Credibility (Mean Scores on Relevant Survey Questions) | 4.7 score on a scale | Standard Deviation 0.5 |
Secondary
Learner Perspectives on Leader Inclusiveness (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement From now on, physicians in this ICU are likely to strike an appropriate balance between authority and openness to suggestion. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Perspectives on Leader Inclusiveness (Mean Scores on Relevant Survey Questions) | 3.9 score on a scale | Standard Deviation 0.5 |
| Interprofessional Education Group - Learners | Learner Perspectives on Leader Inclusiveness (Mean Scores on Relevant Survey Questions) | 4.7 score on a scale | Standard Deviation 0.5 |
| Just-in-time Education Group - Learners | Learner Perspectives on Leader Inclusiveness (Mean Scores on Relevant Survey Questions) | 4.2 score on a scale | Standard Deviation 0.9 |
Secondary
Learner Psychological Safety (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement I'm confident that when I make suggestions, other members of the care team will listen. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Psychological Safety (Mean Scores on Relevant Survey Questions) | 3.9 score on a scale | Standard Deviation 0.7 |
| Interprofessional Education Group - Learners | Learner Psychological Safety (Mean Scores on Relevant Survey Questions) | 4.6 score on a scale | Standard Deviation 0.5 |
| Just-in-time Education Group - Learners | Learner Psychological Safety (Mean Scores on Relevant Survey Questions) | 4.7 score on a scale | Standard Deviation 0.5 |
Secondary
Learner Role Clarity (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In assessing mechanically ventilated patients for potential extubation, I know what my responsibilities are. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Role Clarity (Mean Scores on Relevant Survey Questions) | 4.2 score on a scale | Standard Deviation 0.7 |
| Interprofessional Education Group - Learners | Learner Role Clarity (Mean Scores on Relevant Survey Questions) | 4.9 score on a scale | Standard Deviation 0.3 |
| Just-in-time Education Group - Learners | Learner Role Clarity (Mean Scores on Relevant Survey Questions) | 4.8 score on a scale | Standard Deviation 0.4 |
Secondary
Learner Specialization (Mean Scores on Relevant Survey Questions)
Using a 5-point Likert scale (1=strongly disagree; 5=strongly agree), learners reported their level of agreement with the statement In assessing mechanically ventilated patients for potential extubation, I have knowledge that no other team member has. This outcome only applies to learner participants.
Time frame: Up to 10 weeks
Population: The Overall Number of Participants Analyzed is not consistent with numbers provided in the Participant Flow module because some learner participants did not complete the survey the assessed this outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Traditional Online Continuing Education Group - Learners | Learner Specialization (Mean Scores on Relevant Survey Questions) | 3.6 score on a scale | Standard Deviation 1.1 |
| Interprofessional Education Group - Learners | Learner Specialization (Mean Scores on Relevant Survey Questions) | 3.4 score on a scale | Standard Deviation 1.3 |
| Just-in-time Education Group - Learners | Learner Specialization (Mean Scores on Relevant Survey Questions) | 3.3 score on a scale | Standard Deviation 1.2 |
Secondary
Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation
This implementation outcome only applies to patient participants.
Time frame: Participants will be followed for the duration of their hospital admission, estimated to be 1-2 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Traditional Online Continuing Education Group - Learners | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 2 Participants |
| Interprofessional Education Group - Learners | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 2 Participants |
| Just-in-time Education Group - Learners | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 2 Participants |
| Interprofessional Education Group - Pre-education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 0 Participants |
| Interprofessional Education - During Education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 1 Participants |
| Interprofessional Education Group - Post-education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 1 Participants |
| Just-in-time Education - Pre-education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 4 Participants |
| Just-in-time Education Group - During Education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 1 Participants |
| Just-in-time Education Group - Post-education | Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | 5 Participants |