Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation

Kourouche, S; Curtis, K; Munroe, B; Asha, SE; Carey, I; Considine, J; Fry, M; Lyons, J; Middleton, S; Mitchell, R; Shaban, RZ; Unsworth, A; Buckley, T

Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation

Kourouche, S Curtis, K Munroe, B Asha, SE Carey, I Considine, J Fry, M

Lyons, J Middleton, S Mitchell, R Shaban, RZ Unsworth, A Buckley, T

Permalink

Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Australian Critical Care, 2021
Issue Date:: 2021-06-01

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Published VersionAdobe PDF (791.62 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Kourouche, S
dc.contributor.author	Curtis, K
dc.contributor.author	Munroe, B
dc.contributor.author	Asha, SE
dc.contributor.author	Carey, I
dc.contributor.author	Considine, J
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096
dc.contributor.author	Lyons, J
dc.contributor.author	Middleton, S
dc.contributor.author	Mitchell, R
dc.contributor.author	Shaban, RZ
dc.contributor.author	Unsworth, A
dc.contributor.author	Buckley, T
dc.date.accessioned	2021-11-09T04:51:45Z
dc.date.available	2021-04-11
dc.date.available	2021-11-09T04:51:45Z
dc.date.issued	2021-06-01
dc.identifier.citation	Australian Critical Care, 2021
dc.identifier.issn	1036-7314
dc.identifier.uri	http://hdl.handle.net/10453/151447
dc.description.abstract	<h4>Background</h4>Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel.<h4>Objective</h4>The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals.<h4>Methods</h4>This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. Sample medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-sample z-test.<h4>Results/findings</h4>Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min; there was no difference in time to activation between business hours and after-hours; time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval {CI} = 4.8-9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2-17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5-3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5-5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3-2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1-16.1]).<h4>Conclusions</h4>High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Australian Critical Care
dc.relation.isbasedon	10.1016/j.aucc.2021.04.003
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	Australian Critical Care j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / a u c c https://doi.org/10.1016/j.aucc.2021.04.003 1036-7314/©2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)
dc.subject	1103 Clinical Sciences, 1110 Nursing
dc.subject.classification	Nursing
dc.title	Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation
dc.type	Journal Article
utslib.location.activity	Australia
utslib.for	1103 Clinical Sciences
utslib.for	1110 Nursing
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	*
dc.date.updated	2021-11-09T04:51:44Z
pubs.publication-status	Published

Abstract:

Background

Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel.

Objective

The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals.

Methods

This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. Sample medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-sample z-test.

Results/findings

Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min; there was no difference in time to activation between business hours and after-hours; time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval {CI} = 4.8-9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2-17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5-3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5-5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3-2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1-16.1]).

Conclusions

High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/151447