Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion
Open Access
- 18 October 2021
- journal article
- research article
- Published by BMJ in BMJ Open Quality
- Vol. 10 (4), e001222
- https://doi.org/10.1136/bmjoq-2020-001222
Abstract
Introduction Avoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention. Methods The intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion. With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments. Ethics and dissemination Approval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means. Trial registration number ClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.Keywords
Funding Information
- National Heart, Lung, and Blood Institute (K12HL137942)
This publication has 51 references indexed in Scilit:
- Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trialImplementation Science, 2013
- Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research AgendaAdministration and Policy in Mental Health and Mental Health Services Research, 2010
- The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendationsClinical Psychology Review, 2010
- Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challengesAdministration and Policy in Mental Health and Mental Health Services Research, 2008
- Audit and feedback: effects on professional practice and health care outcomesPublished by Wiley ,2006
- How Many Interviews Are Enough?Field Methods, 2006
- Emergency Physicians' Fear of Malpractice in Evaluating Patients With Possible Acute Cardiac IschemiaAnnals of Emergency Medicine, 2005
- Outcomes of Adoption: Measuring Evidence Uptake by Individuals and OrganizationsWorldviews on Evidence-Based Nursing, 2004
- Audit and feedback: effects on professional practice and health care outcomesPublished by Wiley ,2003
- Sample size in qualitative researchResearch in Nursing & Health, 1995