METEOR Think NIV Pilot

Study Overview
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Brief Summary
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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
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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.

Official Title
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Maximizing Extubation Outcomes Through Educational and Organizational Research: Think NIV Pilot Study

Conditions
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Acute Respiratory Failure

Intervention / Treatment
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* Behavioral: Traditional online continuing education
* Behavioral: Interprofessional education
* Behavioral: Just-in-time education


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional online continuing education<br> | Behavioral: Traditional online continuing education<br>* 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<br>|
| Active Comparator: Interprofessional education<br> | Behavioral: Interprofessional education<br>* 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<br>|
| Active Comparator: Just-in-time education<br> | Behavioral: Just-in-time education<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of ICU Team Members (Learners) Who Received Education | This implementation outcome measuring reach only applies to learner participants. | Up to 1 month | 
| 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. | Up to 10 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of High-risk Patients Without Contraindications Who Received Post-extubation Noninvasive Ventilation | This implementation outcome only applies to patient participants. | Participants will be followed for the duration of their hospital admission, estimated to be 1-2 weeks | 
| 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. | Up to 10 weeks | 
| 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. | Up to 10 weeks | 
| 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. | Up to 10 weeks | 
| 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. | Up to 10 weeks | 
| 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. | Up to 10 weeks | 
| 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. | Up to 10 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Noninvasive ventilation, Education, Intensive care unit, Mechanical ventilation, Evidence-based practice