REASSESSING PRACTICES IN THE DAILY CARE OF CRITICALLY ILL PATIENTS: OPPORTUNITIES TO IDENTIFY AND CLOSE EVIDENCE-CARE GAPS.

Project Title: Reassessing Practices in the Daily Care of Critically Ill Patients: Opportunities to Identify and Close Evidence-care Gaps.

Primary Investigator: Dr. H. Tom Stelfox (PI); Dr. Sean Bagshaw (Co-PI)

Research Associates: Rebecca Brundin-Mather

Patient and Family Advisors: Peter Oxland

Award: $ 748,790

Funding Body: Alberta Innovates

Overview:

Failure to implement best available research evidence into clinical practice is among the largest deficiencies in modern healthcare. These ‘evidence care gaps’ can result in inappropriate, ineffective, and inefficient care. This is a particularly significant issue in intensive care units (ICU) where many expensive tests and treatments are used daily in an effort to save lives. Strategically designed to optimize the integration of best practices into clinical care and improve value for money spent, this AI-PRIHS funded study is structured into four progressive phases: engage stakeholders, including ICU providers, decision-makers, and former ICU patients and family members, to identify and prioritize perceived gaps in care (Phase I), audit care practices to assess if perceived gaps are actual gaps in care (Phase II), identify key facilitators and barriers to adopting best practices and build a suite of tailored knowledge translation (KT) interventions to improve care (Phase III), and finally, pilot test the implementation and impact of the interventions (Phase IV).

We are currently working on the final phase of this study. Venous Thromboembolism (VTE) prevention was selected as the candidate quality improvement opportunity to pilot. Interventions to improve uptake of best practices in VTE prophylaxis delivery were implemented into four medical-surgical ICUs. Evaluation of its impact on provider practice, patient outcomes, and hospital costs will help inform effective strategies to accelerate the integration of scientific evidence into patient care and improve quality and cost of ICU care.

Citations: 

McKenzie E, Potestio ML, Boyd JM, Niven DJ, Brundin-Mather R, Bagshaw SM, et al. Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making. Health Expect. 2017.

Gill M, Bagshaw SM, McKenzie E, Oxland P, Oswell D, Boulton D, et al. Patient and Family Member-Led Research in the Intensive Care Unit: A Novel Approach to Patient-Centered Research. PLoS One. 2016;11(8):e0160947.

Potestio ML, Boyd JM, Bagshaw SM, Heyland D, Oxland P, Doig CJ, et al. Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum. PLoS One. 2015;10(11):e0143088.

Stelfox HT, Niven DJ, Clement FM, Bagshaw SM, Cook DJ, McKenzie E, et al. Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care. PLoS One. 2015;10(10):e0140141.

Community Engagement Activities: PaCER focus groups - 2013/2014; Café Scientifique - June 5, 2014; Reconciliation Panel - November 14, 2014