The purpose of the study is to implement a patient-provider dyad tailored, Electronic Health Record (EHR)-informed, digitized Smart Checklist as a Quality Improvement (QI) intervention to support bedside clinician teams to reduce Adverse Airway Outcomes (AAO) across 6 diverse pediatric intensive care units (ICUs).
More than 20% of the critically ill children who require tracheal intubation suffer from adverse events. To reduce the adverse event risk, and optimize bedside team performance investigators will implement a digitized Smart Checklist that has three specific features: (1) prompts based on patient characteristics, (2) direct display of difficult airway status and airway information, and (3) high-risk warning based on predictive analytics. This is a stepped-wedge cluster randomized trial of PICU patients who are intubated across 6 participating hospitals to determine if the Smart Checklist reduces the incidence of adverse tracheal intubation associated events. The primary objective of this study is to determine the clinical impact of the personalized, dynamic, adaptive Smart Checklist implementation on the occurrence of Adverse Airway Outcomes (AAOs) in the pediatric ICU. The secondary objective is to characterize work systems and processes that affect clinical impact of the digitized Smart Checklist.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
3,000
The digitized Smart Checklist includes three new features that currently do not exist on a paper checklist: 1) decision support prompts based on patient-provider dyad characteristics, 2) real time display of patient pertinent airway information from the EHR, and 3) high-risk warning alerts based on predictive analytics with potential explanatory factors from the model.
University of Arkansas
Little Rock, Arkansas, United States
RECRUITINGEmory University
Atlanta, Georgia, United States
RECRUITINGUniversity of Nebraska Medical Center
Omaha, Nebraska, United States
Adverse Airway Outcomes
A composite outcome for adverse events or acute oxygen desaturation \<80%
Time frame: During the intubation procedure and up to 20 minutes after procedure
Duration of invasive mechanical ventilation
Duration of invasive mechanical ventilation (time to extubation or tracheostomy)
Time frame: During the ICU stay, up to 180 days
Duration of ICU stay
Duration of ICU stay (days)
Time frame: During the ICU stay, up to 180 days
ICU mortality
ICU mortality (all cause)
Time frame: During the ICU stay, up to 180 days
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Akron Children's Hospital
Akron, Ohio, United States
RECRUITINGHasbro Children's Hospital
Providence, Rhode Island, United States
RECRUITINGUniversity of Virginia
Charlottesville, Virginia, United States
RECRUITING