Awakening and Breathing Coordination: A Mixed-Methods Analysis of Determinants of Implementation

作者：Griffin H. Olsen, Perry M. Gee, Doug Wolfe, Carrie Winberg, Lori Carpenter, Chris Jones, Jason R. Jacobs, Lindsay Leither, Ithan D. Peltan, Sara J. Singer, Steven M. Asch, Colin K. Grissom, Rajendu Srivastava, Andrew J. Knighton · 发表于：Annals of the American Thoracic Society · 年份：2023 · DOI：10.1513/annalsats.202212-1048oc · 被引用次数：12 · 研究领域：Intensive Care Unit Cognitive Disorders、Family and Patient Care in Intensive Care Units、Geriatric Care and Nursing Homes

Abstract Rationale Routine spontaneous awakening and breathing trial coordination (SAT/SBT) improves outcomes for mechanically ventilated patients, but adherence varies. Understanding barriers to and facilitators of consistent daily use of SAT/SBT (implementation determinants) can guide the development of implementation strategies to increase adherence to these evidence-based interventions. Objectives We conducted an explanatory, sequential mixed-methods study to measure variation in the routine daily use of SAT/SBT and to identify implementation determinants that might explain variation in SAT/SBT use across 15 intensive care units (ICUs) in urban and rural locations within an integrated, community-based health system. Methods We described the patient population and measured adherence to daily use of coordinated SAT/SBT from January to June 2021, selecting four sites with varied adherence levels for semistructured field interviews. We conducted key informant interviews with critical care nurses, respiratory therapists, and physicians/advanced practice clinicians (n = 55) from these four sites between October and December 2021 and performed content analysis to identify implementation determinants of SAT/SBT use. Results The 15 sites had 1,901 ICU admissions receiving invasive mechanical ventilation (IMV) for ⩾24 hours during the measurement period. The mean IMV patient age was 58 years, and the median IMV duration was 5.3 days (interquartile range, 2.5–11.9). Coordinated SAT/...