Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation

Abstract

Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018

Rethinking the tiered trauma team response: A case‐series study in a regional trauma centre

“…Theory can be used to identify the clinical behaviour being targeted for change and find techniques to modify it 22 . In our hospital, as we have previously described, this consisted of monitoring of compliance, performance feedback, role modelling, training, education and enablement 26 . Next steps could include multi‐disciplinary monthly trauma case reviews, not restricted only to trauma committee members, but all those who are involved in managing trauma patients.…”

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review

“…(Curtis et al, 2017). The context suitability should also need to be considered, using a tool such as the APEASE criteria (APEASE criteria: Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety and Equity) (Michie et al, 2011), which has been shown to be an important tool for evaluating a concept for intervention (Curtis, Kourouche, et al, 2021).…”

The Emergency nurse Protocols Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) trial: protocol for a stepped wedge implementation trial

“…Intervention functions are ‘broad categories by means of which an intervention can change behaviour’ [ 20 ]. We used this approach successfully to test interventions in the ED previously (2021) [ 10 , 24 , 25 ]. The implementation toolkit will be refined for each cluster using mechanisms from the behaviour change techniques taxonomy and the APEASE criteria that consider affordability, practicality, effectiveness/cost-effectiveness, acceptability, side-effects/safety, and equity [ 20 ].…”