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

Curtis, K; Kourouche, S; Asha, S; Considine, J; Fry, M; Middleton, S; Mitchell, R; Munroe, B; Shaban, RZ; D'Amato, A; Skinner, C; Wiseman, G; Buckley, T

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

Curtis, K Kourouche, S Asha, S Considine, J Fry, M

Middleton, S Mitchell, R Munroe, B Shaban, RZ D'Amato, A Skinner, C Wiseman, G Buckley, T

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Publisher:: Public Library of Science (PLoS)
Publication Type:: Journal Article
Citation:: PLoS One, 2021, 16, (10)
Issue Date:: 2021-01

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Field	Value	Language
dc.contributor.author	Curtis, K
dc.contributor.author	Kourouche, S
dc.contributor.author	Asha, S
dc.contributor.author	Considine, J
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096
dc.contributor.author	Middleton, S
dc.contributor.author	Mitchell, R
dc.contributor.author	Munroe, B
dc.contributor.author	Shaban, RZ
dc.contributor.author	D'Amato, A
dc.contributor.author	Skinner, C
dc.contributor.author	Wiseman, G
dc.contributor.author	Buckley, T
dc.date.accessioned	2021-11-09T04:45:32Z
dc.date.available	2021-07-28
dc.date.available	2021-11-09T04:45:32Z
dc.date.issued	2021-01
dc.identifier.citation	PLoS One, 2021, 16, (10)
dc.identifier.issn	1932-6203
dc.identifier.issn	1932-6203
dc.identifier.uri	http://hdl.handle.net/10453/151445
dc.description.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.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	Public Library of Science (PLoS)
dc.relation.ispartof	PLoS One
dc.relation.isbasedon	10.1371/journal.pone.0256027
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	General Science & Technology
dc.title	Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation.
dc.type	Journal Article
utslib.citation.volume	16
utslib.location.activity	United States
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2021-11-09T04:45:29Z
pubs.issue	10
pubs.publication-status	Published
pubs.volume	16
utslib.citation.issue	10

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.

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http://hdl.handle.net/10453/151445