Telehealth-Enabled, Real-time Audit and Feedback for Clinician AdHerence (TEACH)
Study Details
Study Description
Brief Summary
The purpose of this trial is to evaluate if augmenting a usual audit and feedback implementation approach with telehealth-enabled support improves coordinated spontaneous awakening/breathing trials and patient outcomes for mechanically ventilated patients.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Sedation and analgesia are utilized with invasive mechanical ventilation (IMV) to improve patient comfort and synchrony with the mechanical ventilator. Prolonged sedation, however, may result in increased time on IMV and increased risk for ventilator associated pneumonia, delirium, and poor long-term cognitive outcomes. Daily interruptions in sedation [spontaneous awakening trials (SAT)] coordinated with daily spontaneous breathing trials (SBT) reduce mortality, increase ventilator free days, decrease intensive care unit (ICU) length of stay, and reduces ventilator-associated events. Coordination of spontaneous awakening and breathing trials (C-SAT/SBT), however, are underutilized due to significant barriers to implementation and adherence. This cluster-randomized hybrid implementation/effectiveness trial will compare C-SAT/SBT adherence and clinical outcomes in the presence of traditional audit and feedback implementation strategies alone or augmented with a novel Telehealth-Enabled, real-time Audit and feedback for Clinician adHerence ("TEACH") implementation strategy.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention - Telehealth- enabled support plus usual audit and feedback for SAT/SBT adherence Usual audit and feedback + telehealth-enabled support |
Other: Telehealth- enabled support for SAT/SBT adherence
Telehealth-enabled support over and above usual audit and feedback includes identifying candidates for spontaneous awakening and breathing trials, prompting bedside providers and guiding execution of the coordinated spontaneous awakening and breathing trials as needed.
Other: Usual audit and feedback for SAT/SBT adherence
Usual audit and feedback
|
| Active Comparator: Control - Usual audit/feedback for SAT/SBT adherence only Usual audit and feedback |
Other: Usual audit and feedback for SAT/SBT adherence
Usual audit and feedback
|
Outcome Measures
Primary Outcome Measures
- Adherence to C-SAT/SBT [intubation to extubation - an average of 5 days]
Fraction of eligible days on which coordinated spontaneous awakening trial and spontaneous breathing trial completed.
- Ventilator-free days to day 28 [28 days]
ventilator-free days to day 28
Secondary Outcome Measures
- 30-day Mortality [30 days]
- Hospital Length of Stay [Through hospital discharge, an average of 10 days]
- 90-day Mortality [90 Days]
- New ventilator-associated pneumonia [Through hospital discharge, an average of 10 days]
- ICU Length of Stay [Through hospital discharge, an average of 10 days]
- Reintubation [intubation to extubation - an average of 5 days]
- Unintentional Extubation [intubation to extubation - an average of 5 days]
Eligibility Criteria
Criteria
Inclusion criteria:
-
Patient age >=16 years admitted to study hospital ICU
-
Intubated and mechanically ventilated
Exclusion criteria:
-
Patient with pre-existing brain death admitted to study hospital for organ donation
-
Died within 24 hours of intubation
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | American Fork Hospital | American Fork | Utah | United States | 84003 |
| 2 | Cedar City Hospital | Cedar City | Utah | United States | 84721 |
| 3 | Layton Hospital | Layton | Utah | United States | 84041 |
| 4 | Logan Regional Hospital | Logan | Utah | United States | 84341 |
| 5 | Intermountain Medical Center | Murray | Utah | United States | 84107 |
| 6 | Mckay Dee Hospital | Ogden | Utah | United States | 84403 |
| 7 | Utah Valley Hospital | Provo | Utah | United States | 84604 |
| 8 | Riverton Hospital | Riverton | Utah | United States | 84065 |
| 9 | St. George Regional Hospital | Saint George | Utah | United States | 84790 |
| 10 | LDS Hospital | Salt Lake City | Utah | United States | 84143 |
| 11 | Alta View Hospital | Sandy | Utah | United States | 84094 |
Sponsors and Collaborators
- Intermountain Health Care, Inc.
- University of Utah
- National Heart, Lung, and Blood Institute (NHLBI)
Investigators
- Principal Investigator: Colin Grissom, MD, Intermountain Health Care, Inc.
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 1051681
- U01HL159878