Trial Summary

Survivors of critical illness frequently experience profound health impairments brought about or exacerbated by outdated mechanical ventilation and symptom management practices in the intensive care unit (ICU) and by known racial and socioeconomic disparities. This morbidity is potentially preventable through use of the ABCDEF bundle, a multicomponent, evidence-based intervention that improves team-based care in the ICU. Although the ABCDEF bundle has consistently been proven safe and effective, its adoption and performance remain poor nationwide. The BEST-ICU trial is evaluating 2 strategies grounded in behavioral economic theory and implementation science to increase ABCDEF bundle adoption. The strategies target a variety of ICU team members and known behavioral determinants of bundle performance. In the trial’s planning phase, the study team worked with the NIH Pragmatic Trials Collaboratory Coordinating Center and community partners to enhance and finalize the implementation strategies and research methods. In the implementation phase, the study team is conducting a pragmatic, stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial. The participating sites include 6 matched pairs of 12 ICUs in 3 hospitals (providing care for approximately 8100 patients on mechanical ventilation). The study team will randomly assign the ICUs within each matched pair to receive either a real-time audit and feedback dashboard using data from the electronic health record, or a registered nurse implementation facilitator. The trial will compare the effectiveness of the 2 strategies on ABCDEF bundle adoption (the primary outcome) and several clinical outcomes, including duration of mechanical ventilation; ICU, hospital, and 30-day mortality; ICU and hospital length of stay; days with acute brain dysfunction; discharge disposition; use of psychoactive medications and physical therapy; and 30-day hospital readmission. The study team will also identify and describe key stakeholders’ experiences with and perspectives on the acceptability of the implementation strategies and their impact on workload. The long-term goal of BEST-ICU is to develop pragmatic, sustainable strategies to increase the delivery of evidence-based practices that improve care for critically ill adults across a variety of healthcare systems, particularly those serving populations with known health disparities, such as safety net hospitals.

NIH Project Information