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Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study
OBJECTIVES: Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extub...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362728/ https://www.ncbi.nlm.nih.gov/pubmed/34385234 http://dx.doi.org/10.1136/bmjopen-2020-045674 |
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author | Sarti, Aimee J Zheng, Katina Herry, Christophe L Sutherland, Stephanie Scales, Nathan B Watpool, Irene Porteous, Rebecca Hickey, Michael Anstee, Caitlin Fazekas, Anna Ramsay, Tim Burns, Karen EA Seely, Andrew JE |
author_facet | Sarti, Aimee J Zheng, Katina Herry, Christophe L Sutherland, Stephanie Scales, Nathan B Watpool, Irene Porteous, Rebecca Hickey, Michael Anstee, Caitlin Fazekas, Anna Ramsay, Tim Burns, Karen EA Seely, Andrew JE |
author_sort | Sarti, Aimee J |
collection | PubMed |
description | OBJECTIVES: Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extubation decision support (CDS) tool. DESIGN: Phase I mixed-methods observational study. SETTING: Two Canadian intensive care units (ICUs). PARTICIPANTS: We included patients on mechanical ventilation for ≥24 hours and clinicians (respiratory therapists and intensivists) responsible for extubation decisions. INTERVENTIONS: Components included a predictive model assessment, feasibility evaluation, questionnaires and interviews with clinicians. RESULTS: We enrolled 117 patients, totalling 151 SBTs and 80 extubations. The incidence of extubation failure was 11% in low-risk patients and 21% in high-risk patients stratified by the predictive model; 38% failed extubation when both the model and clinical impression were at high risk. The tool was well rated: 94% and 75% rated the data entry and EA report as average or better, respectively. Interviews (n=15) revealed favourable impressions regarding its user interface and functionality, but unexpectedly, also concerns regarding EA’s potential impact on respiratory therapists’ job security. CONCLUSIONS: EA implementation was feasible, and users perceived it to have potential to support extubation decision-making. This study helps to understand bedside implementation of CDS tools in a multidisciplinary ICU. TRIAL REGISTRATION NUMBER: NCT02988167. |
format | Online Article Text |
id | pubmed-8362728 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-83627282021-08-30 Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study Sarti, Aimee J Zheng, Katina Herry, Christophe L Sutherland, Stephanie Scales, Nathan B Watpool, Irene Porteous, Rebecca Hickey, Michael Anstee, Caitlin Fazekas, Anna Ramsay, Tim Burns, Karen EA Seely, Andrew JE BMJ Open Intensive Care OBJECTIVES: Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extubation decision support (CDS) tool. DESIGN: Phase I mixed-methods observational study. SETTING: Two Canadian intensive care units (ICUs). PARTICIPANTS: We included patients on mechanical ventilation for ≥24 hours and clinicians (respiratory therapists and intensivists) responsible for extubation decisions. INTERVENTIONS: Components included a predictive model assessment, feasibility evaluation, questionnaires and interviews with clinicians. RESULTS: We enrolled 117 patients, totalling 151 SBTs and 80 extubations. The incidence of extubation failure was 11% in low-risk patients and 21% in high-risk patients stratified by the predictive model; 38% failed extubation when both the model and clinical impression were at high risk. The tool was well rated: 94% and 75% rated the data entry and EA report as average or better, respectively. Interviews (n=15) revealed favourable impressions regarding its user interface and functionality, but unexpectedly, also concerns regarding EA’s potential impact on respiratory therapists’ job security. CONCLUSIONS: EA implementation was feasible, and users perceived it to have potential to support extubation decision-making. This study helps to understand bedside implementation of CDS tools in a multidisciplinary ICU. TRIAL REGISTRATION NUMBER: NCT02988167. BMJ Publishing Group 2021-08-12 /pmc/articles/PMC8362728/ /pubmed/34385234 http://dx.doi.org/10.1136/bmjopen-2020-045674 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Intensive Care Sarti, Aimee J Zheng, Katina Herry, Christophe L Sutherland, Stephanie Scales, Nathan B Watpool, Irene Porteous, Rebecca Hickey, Michael Anstee, Caitlin Fazekas, Anna Ramsay, Tim Burns, Karen EA Seely, Andrew JE Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title_full | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title_fullStr | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title_full_unstemmed | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title_short | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
title_sort | feasibility of implementing extubation advisor, a clinical decision support tool to improve extubation decision-making in the icu: a mixed-methods observational study |
topic | Intensive Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362728/ https://www.ncbi.nlm.nih.gov/pubmed/34385234 http://dx.doi.org/10.1136/bmjopen-2020-045674 |
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