Behavioral Economic and Staffing Strategies To Increase Adoption of an Evidence Based Bundle in the Intensive Care Unit A Stepped Wedge Cluster Randomized Controlled Trial

What this Trial Is About

Millions of adults who survive critical illness suffer lasting physical, mental, and cognitive problems often linked to care received in intensive care units (ICUs). These health issues are worsened by racial and socioeconomic disparities and outdated care practices. Researchers are studying ways to improve the use of the ABCDEF bundle, an evidence-based approach to managing mechanical ventilation and symptoms early during critical illness, which is known to improve patient outcomes but is underused in many ICUs. This study compares two behavioral strategies aimed at increasing adoption of the ABCDEF bundle in ICUs: real-time audit and feedback via an electronic dashboard showing performance data, and support from a registered nurse (RN) who helps implement the bundle. Twelve ICUs in three hospitals will be grouped and randomly assigned to receive usual care, the audit and feedback, or RN facilitation in a stepped-wedge design over 27 months, followed by a 3-month period without the strategies to assess lasting effects. Participants include critically ill adults over 19 years old who have received invasive mechanical ventilation and stayed in the ICU for at least 24 hours. Researchers will evaluate bundle adoption rates, duration of mechanical ventilation, and various patient-centered outcomes like mortality, delirium, medication use, and hospital readmission. The study also examines staff experiences, workload, and barriers to adopting these strategies, with data collected throughout the trial and during the follow-up period.

Behavioral Economic & Staffing Strategies in the ICU