Clinical trial NCT06146348: Deimplementing CXR After CVC (DRAUP) in the ICU
Official title: Adapting and Testing a Deimplementation Program in the Intensive Care Unit
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Implementation Science
Behavior and Behavior Mechanisms
Lead sponsor: Washington University School of Medicine
Sponsor class: OTHER
Collaborators: name: National Heart, Lung, and Blood Institute (NHLBI)
First posted: 2023-11-24
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: This study proposes adapting and testing an innovative, behavioral theory-driven deimplementation program called DRAUP in two intensive care units for proof of concept and support that the program can help providers and hospital organizations address context determinants of deimplementation. Study data will be used to optimize the intervention for a subsequent larger trials.

Detailed description: There are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. Previously, we developed and initiated a successful evidence-based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We now move to adapt the deimplementation bundle in the new environment of the Intensive Care Unit (ICU) with hopeful continued success.

In experiment 1, qualitative analysis will be employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit and implementation outcomes as well as cost will be evaluated. In experiment 3, mixed methods will be used to evaluate the mechanism of impact of the refined program in the new environment.

Eligibility criteria: -Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs

Inclusion Criteria for DRAUP training:

(1) ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners

* ICU inclusion for DRAUP program:
* Availability of ultrasound machines with archiving capability (DICOM)
* A minimum of 100 supradiaphragmatic CVC insertions annually in adult patients (age \>18)
* Capacity to access digital archiving (PICOM)
* Patient inclusion for DRAUP program:
* supradiaphragmatic CVC placed
* Patient exclusion for DRAUP program:
* severe instability (cardiac arrest, severe shock) where CVC would be used without CXR,
* level 1 trauma;
* burn patients with no viable skin surface for imaging

Primary outcomes:
measure: DRAUP in
timeFrame: 24 months
Secondary outcomes:
measure: Fidelity
timeFrame: 24 months
Other outcomes:
Locations:
city: St Louis
country: United States
facility: Washington University School of Medicine
state: Missouri
Study officials:
affiliation: Washington University School of Medicine
name: Enyo Ablordeppey, MD MPH
role: PRINCIPAL_INVESTIGATOR
References: