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

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posted on 2021-01-01, 00:00 authored by K Curtis, S Kourouche, S Asha, Julie ConsidineJulie Considine, M Fry, S Middleton, R Mitchell, B Munroe, R Z Shaban, A D'Amato, C Skinner, G Wiseman, T Buckley

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.


Trial registration
ANZCTR: ACTRN12618001548224, approved 17/09/2018

History

Journal

PLoS ONE

Volume

16

Issue

10

Article number

0256027

Pagination

1 - 15

Publisher

Public Library of Science (PLoS)

Location

San Francisco, Calif.

ISSN

1932-6203

eISSN

1932-6203

Language

en

Publication classification

C1 Refereed article in a scholarly journal

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