Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS), a feature of severe coronavirus disease 2019 (COVID-19). Despite this, most patients with ARDS do not receive this lifesaving therapy. Objectives: To identify determinants of prone-positioning use, to develop specific implementation strategies, and to incorporate strategies into an overarching response to the COVID-19 crisis. Methods: We used an implementation-mapping approach guided by implementation-science frameworks. We conducted semistructured interviews with 30 intensive care unit (ICU) clinicians who staffed 12 ICUs within the Penn Medicine Health System and the University of Michigan Medical Center. We performed thematic analysis using the Consolidated Framework for Implementation Research. We then conducted three focus groups with a task force of ICU leaders to develop an implementation menu, using the Expert Recommendations for Implementing Change framework. The implementation strategies were adapted as part of the Penn Medicine COVID-19 pandemic response. Results: We identified five broad themes of determinants of prone positioning, including knowledge, resources, alternative therapies, team culture, and patient factors, which collectively spanned all five Consolidated Framework for Implementation Research domains. The task force developed five specific implementation strategies, including educational outreach, learning collaborative, clinical protocol, prone-positioning team, and automated alerting, elements of which were rapidly implemented at Penn Medicine.Conclusions: We identified five broad themes of determinants of evidence-based use of prone positioning for severe ARDS and several specific strategies to address these themes. These strategies may be feasible for rapid implementation to increase use of prone positioning for severe ARDS with COVID-19.
Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS), a feature of severe coronavirus disease 2019 (COVID-19). Despite this, most patients with ARDS do not receive this lifesaving therapy. Objectives: To identify determinants of prone-positioning use, to develop specific implementation strategies, and to incorporate strategies into an overarching response to the COVID-19 crisis. Methods: We used an implementation-mapping approach guided by implementation-science frameworks. We conducted semistructured interviews with 30 intensive care unit (ICU) clinicians who staffed 12 ICUs within the Penn Medicine Health System and the University of Michigan Medical Center. We performed thematic analysis using the Consolidated Framework for Implementation Research. We then conducted three focus groups with a task force of ICU leaders to develop an implementation menu, using the Expert Recommendations for Implementing Change framework. The implementation strategies were adapted as part of the Penn Medicine COVID-19 pandemic response. Results: We identified five broad themes of determinants of prone positioning, including knowledge, resources, alternative therapies, team culture, and patient factors, which collectively spanned all five Consolidated Framework for Implementation Research domains. The task force developed five specific implementation strategies, including educational outreach, learning collaborative, clinical protocol, prone-positioning team, and automated alerting, elements of which were rapidly implemented at Penn Medicine.Conclusions: We identified five broad themes of determinants of evidence-based use of prone positioning for severe ARDS and several specific strategies to address these themes. These strategies may be feasible for rapid implementation to increase use of prone positioning for severe ARDS with COVID-19.
Authors: Chad H Hochberg; Kevin J Psoter; Sarina K Sahetya; Eric P Nolley; Shakir Hossen; William Checkley; Meeta P Kerlin; Michelle N Eakin; David N Hager Journal: Crit Care Explor Date: 2022-05-13
Authors: Yi Xin; Kevin Martin; Caio C A Morais; Paolo Delvecchio; Sarah E Gerard; Hooman Hamedani; Jacob Herrmann; Nicholas Abate; Austin Lenart; Shiraz Humayun; Uday Sidhu; Mihail Petrov; Kristan Reutlinger; Tal Mandelbaum; Ian Duncan; Nicholas Tustison; Stephen Kadlecek; Shampa Chatterjee; James C Gee; Rahim R Rizi; Lorenzo Berra; Maurizio Cereda Journal: Crit Care Med Date: 2021-10-01 Impact factor: 9.296
Authors: Katelin Hoskins; Amanda L Sanchez; Carlin Hoffacker; Florence Momplaisir; Robert Gross; Kathleen A Brady; Amy R Pettit; Kelly Zentgraf; Chynna Mills; DeAuj'Zhane Coley; Rinad S Beidas Journal: Front Public Health Date: 2022-08-02
Authors: Rinad S Beidas; Shannon Dorsey; Cara C Lewis; Aaron R Lyon; Byron J Powell; Jonathan Purtle; Lisa Saldana; Rachel C Shelton; Shannon Wiltsey Stirman; Meghan B Lane-Fall Journal: Implement Sci Date: 2022-08-13 Impact factor: 7.960
Authors: Florian R Schroeck; A Aziz Ould Ismail; David A Haggstrom; Steven L Sanchez; DeRon R Walker; Lisa Zubkoff Journal: Implement Sci Date: 2022-09-01 Impact factor: 7.960
Authors: Geoffrey D Barnes; Emily Sippola; Allison Ranusch; Linda Takamine; Michael Lanham; Michael Dorsch; Anne Sales; Jeremy Sussman Journal: Implement Sci Commun Date: 2022-02-02