Clinical trial NCT00434460: Study of Knowledge Translation of Clinical Practice Guidelines for Ventilator Associated Pneumonia
Official title: Active Observational Study of the Adoption and Transfer of Clinical Practice Guidelines Through Education, for Ventilator Associated Pneumonia (ABATE VAP Study)
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Ventilator Associated Pneumonia
Keywords: Ventilator Associated Pneumonia
Knowledge Translation
Clinical Practice Guidelines
Education
Behaviour Change
Lead sponsor: Canadian Critical Care Trials Group
Sponsor class: OTHER
Collaborators: name: Kingston Health Sciences Centre
name: Canadian Institutes of Health Research (CIHR)
name: AstraZeneca
name: Bayer
First posted: 2007-02-13
Enrollment: 1320
Sex: ALL
Minimum age (years): 17
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients invasively mechanically ventilated \> 48 hours in the critical care setting.

Brief summary: The purpose of this prospective, multicentre, time-series study is to develop, implement, refine, and evaluate a sustainable behaviour change strategy in the intensive care unit (ICU).

Detailed description: Background:

In order to improve the care of our patients, it is necessary for research evidence to be translated into clinical practice. There are gaps in our understanding of knowledge translation (KT) and this is evident in the Intensive Care Unit (ICU), specifically as it applies to the prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP). VAP is associated with a high burden of illness in the critically ill and there is an extensive amount of research evidence on this disease. It has been demonstrated that best practice as defined by research evidence is not uniformly applied to VAP. In addition, recent advances in VAP knowledge need be disseminated and implemented in order to improve patient safety and outcomes from VAP. A systematic process of knowledge transfer is crucial to translate this research into evidence-based bedside practice and the development and implementation of evidence based Clinical Practice Guidelines (CPGs) may facilitate VAP knowledge uptake. In addition, there is a need to study knowledge translation (KT) in the ICU since there is little information about optimal KT and CPG implementation strategies in this environment and efforts that are effective in other clinical areas may not result in meaningful change in the ICU.

Research Question:

What is the effect of VAP CPGs implemented by a multidisciplinary behaviour change strategy (consisting of multifaceted educational strategies led by local opinion leaders and augmented with reminders) on VAP guideline concordance and on clinical VAP outcomes in the ICU?

Research Plan:

Data will only be collected on consecutive patients mechanically ventilated for at least 48 hours. The following health care professionals will be studied to assess the behaviour change strategy for the VAP CPGs: physicians (intensivists, ICU fellows, ICU rotating residents), nurses, respiratory therapists, dieticians, physiotherapists and ICU administrators.

The study will be conducted in 3 phases:

1. Development of a behaviour change strategy consisting of three components:

   * Local opinion leader team
   * Educational strategy
   * Reminder system
2. Prospective implementation of the behaviour change strategy over a 24 month period
3. Prospective evaluation of the behaviour change strategy over a 24 month period

   * Concordance with VAP guidelines over time
   * Factors associated with VAP guideline concordance
   * Clinical VAP outcomes pre- and post-guideline implementation

Eligibility criteria: Inclusion Criteria:

* Age \>= 17 years old
* Mechanically ventilated \> 48 hours \< 96 hours

Exclusion Criteria:

* Previous enrollment in the study

Primary outcomes:
Secondary outcomes:
Other outcomes:
Locations:
city: Danville
country: United States
facility: Geisinger Health Centre, Temple University
state: Pennsylvania
city: New Westminister
country: Canada
facility: Royal Columbian Hospital, University of British Columbia
state: British Columbia
city: Vancouver
country: Canada
facility: St. Paul Hospital, University of British Columbia
state: British Columbia
city: Victoria
country: Canada
facility: Vancouver Island Health Research Centre
state: British Columbia
city: Hamilton
country: Canada
facility: St. Joseph's Healthcare, McMaster University
state: Ontario
city: Kingston
country: Canada
facility: Kingston General Hospital, Queen's University
state: Ontario
city: Ottawa
country: Canada
facility: The Ottawa Hospital, University of Ottawa
state: Ontario
city: Thunder Bay
country: Canada
facility: Thunder Bay Regional Health Sciences Centre
state: Ontario
city: Toronto
country: Canada
facility: Sunnybrook Health Sciences Centre, University of Toronto
state: Ontario
city: Toronto
country: Canada
facility: William Osler Health Centre
state: Ontario
city: Windsor
country: Canada
facility: Hotel Dieu Grace Hospital
state: Ontario
Study officials:
affiliation: Kingston General Hospital, Queen's University
name: John Muscedere, MD
role: STUDY_CHAIR
affiliation: Sunnybrook Health Sciences Centre, University of Toronto
name: Tasmin Sinuff, MD, PhD
role: STUDY_CHAIR
affiliation: Kingston General Hospital, Queen's University
name: Daren Heyland, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: St. Joseph's Healthcare, McMaster University
name: Deborah Cook, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: St. Paul's University, University of British Columbia
name: Peter Dodek, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: The Ottawa Hospital, University of Ottawa
name: Redouane Bouali, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Royal Columbian Hospital, University of British Columbia
name: Sean Keenan, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: McMaster University
name: Kevin Eva, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: London Health Sciences Centre, University of Western Ontario
name: Brenda Morgan, RN
role: PRINCIPAL_INVESTIGATOR
affiliation: Hamilton Health Sciences Centre, McMaster University
name: Lori Hand, RRT
role: PRINCIPAL_INVESTIGATOR
References:
citation: Sinuff T, Muscedere J, Cook DJ, Dodek PM, Anderson W, Keenan SP, Wood G, Tan R, Haupt MT, Miletin M, Bouali R, Jiang X, Day AG, Overvelde J, Heyland DK; Canadian Critical Care Trials Group. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med. 2013 Jan;41(1):15-23. doi: 10.1097/CCM.0b013e318265e874.