Evaluation of the Effectiveness of an Audit and Feedback Intervention With Quality Improvement Toolbox in Intensive Care

NCT02922101 | Completed

• 1 other identifier: METC_W16_271
• Study Type: interventional
• Target: 21
• Locations: 1 country
• Sites: 1

Brief Summary

This study evaluates the addition of a quality improvement toolbox to an online audit and feedback intervention in Dutch intensive care units. The toolbox comprises for each quality indicator (e.g., percentage of patients per shift whose pain is measured) a list of potential bottlenecks in the care process (e.g., staff is unaware of the prevailing guidelines for measuring pain every shift), associated recommendations for actions to solve mentioned bottlenecks (e.g., organize an educational training session), and supporting materials to facilitate implementation of the actions (e.g., a slide show presentation discussing the importance and relevance of measuring pain every shift). Half of the participating intensive care units will only receive online feedback, while the other half will additionally gain access to the integrated toolbox to facilitate planning and executing actions.

Conditions

Pain Management; Critical Care; Quality Improvement

Outcome Measures

Primary Outcomes (1)

• Change from proportion of patient shifts during which pain has been adequately managed

  "Adequately managed" is defined: pain measured AND (acceptable pain score OR (unacceptable pain score AND normalized within 1 hour)). The primary outcome measure is a composite score of four quality indicators (= secondary outcome measures).The measure is limited to only patients' first 12 shifts to prevent bias from patients with a long stay. There are 3 shifts in 1 day.

  9 months

Secondary Outcomes (4)

• Change from proportion of patient shifts during which pain was measured at least once

  9 months

• Change from proportion of patient shifts during which pain was measured and no unacceptable pain scores were observed

  9 months

• Change from proportion of patient shifts during which an unacceptable pain score was measured, and pain was timely re-measured

  9 months

• Change from proportion of patient shifts during which an unacceptable pain score was measured, and pain was timely re-measured indicating that the pain score was normalized

  9 months

Study Arms (2)

Audit and Feedback with toolbox

EXPERIMENTAL

Access to an online dashboard that provides insight into clinical performance on quality indicators for pain management; including a quality improvement toolbox to facilitate planning and executing actions. Participating ICUs will receive one educational outreach visit and brief monthly telephone calls.

Behavioral: Audit and Feedback; Behavioral: Toolbox

Audit and Feedback without toolbox

ACTIVE COMPARATOR

Same intervention, but without access to the quality improvement toolbox.

Behavioral: Audit and Feedback

Interventions

Audit and Feedback BEHAVIORAL

An online dashboard that provides insight into clinical performance on pain management quality indicators. It also incorporates an empty action plan, in which participating intensive care units can define potential bottlenecks in the care process and what actions they intend to undertake to improve.

Also known as: A&F, Feedback

Audit and Feedback with toolbox; Audit and Feedback without toolbox

Toolbox BEHAVIORAL

A quality improvement toolbox, incorporated within the action plan, that comprises for each pain management quality indicator (e.g., percentage of patients per shift whose pain is measured) a list of potential bottlenecks in the care process (e.g., staff is unaware of the prevailing guidelines for measuring pain every shift), associated recommendations for actions to solve mentioned bottlenecks (e.g., organize an educational training session), and supporting materials to facilitate implementation of the actions (e.g., a slide show presentation discussing the importance and relevance of measuring pain every shift).

Also known as: Quality Improvement Toolbox

Audit and Feedback with toolbox

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ICUs treating adult (18 years and above) patients
• ICUs willing and able to submit data monthly
• ICUs with a local quality improvement team of at least 1 intensivist and 1 nurse

You may not qualify if:

• Nil

Sponsors & Collaborators

• Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA): lead
• National Intensive Care Evaluation Foundation: collaborator

Study Sites (1)

National Intensive Care Evaluation foundation

Amsterdam, North Holland, 1100 EC, Netherlands

Location

Related Publications (4)

• Gude WT, Roos-Blom MJ, van der Veer SN, Dongelmans DA, de Jonge E, Peek N, de Keizer NF. Facilitating action planning within audit and feedback interventions: a mixed-methods process evaluation of an action implementation toolbox in intensive care. Implement Sci. 2019 Sep 18;14(1):90. doi: 10.1186/s13012-019-0937-8.

  PMID: 31533841 DERIVED

• Roos-Blom MJ, Gude WT, de Jonge E, Spijkstra JJ, van der Veer SN, Peek N, Dongelmans DA, de Keizer NF. Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial. BMJ Qual Saf. 2019 Dec;28(12):1007-1015. doi: 10.1136/bmjqs-2019-009588. Epub 2019 Jul 1.

  PMID: 31263017 DERIVED

• Gude WT, Roos-Blom MJ, van der Veer SN, Dongelmans DA, de Jonge E, Francis JJ, Peek N, de Keizer NF. Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units. Implement Sci. 2018 Feb 17;13(1):33. doi: 10.1186/s13012-018-0727-8.

  PMID: 29454393 DERIVED

• Gude WT, Roos-Blom MJ, van der Veer SN, de Jonge E, Peek N, Dongelmans DA, de Keizer NF. Electronic audit and feedback intervention with action implementation toolbox to improve pain management in intensive care: protocol for a laboratory experiment and cluster randomised trial. Implement Sci. 2017 May 25;12(1):68. doi: 10.1186/s13012-017-0594-8.

  PMID: 28545535 DERIVED

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Nicolette F de Keizer, PhD

  Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Full professor of Medical Informatics

Study Record Dates

• First Submitted: September 26, 2016
• First Posted: October 4, 2016
• Study Start: September 1, 2016
• Primary Completion: October 1, 2018
• Study Completion: October 1, 2018
• Last Updated: January 10, 2019

Record last verified: 2019-01

Data Sharing

• IPD Sharing: Will share

Locations

NL (1)