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Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter

Enyo A Ablordeppey1, Byron Powell2, Virginia McKay2

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Summary
This summary is machine-generated.

This study introduces DRAUP, a program to replace chest X-rays with point-of-care ultrasound (POCUS) for central venous catheter confirmation. The goal is to reduce low-value medical imaging in acute care settings.

Keywords:
clinical protocolsimplementation sciencequalitative researchquality improvement methodologies

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Area of Science:

  • Medical Imaging
  • Healthcare Implementation Science
  • Deimplementation Strategies

Background:

  • Low-value medical practices, such as routine chest X-rays for central venous catheter (CVC) confirmation, persist despite evidence favoring point-of-care ultrasound (POCUS).
  • POCUS offers advantages in workflow and timeliness over traditional radiography, yet its adoption for CVC confirmation remains slow, indicating a need for targeted interventions.

Purpose of the Study:

  • To develop and pilot a deimplementation program (DRAUP) aimed at replacing routine chest radiography with POCUS for CVC confirmation in acute care.
  • To explore barriers and facilitators to POCUS adoption and implement strategies to reduce unnecessary imaging practices.

Main Methods:

  • A three-phase approach utilizing the Consolidated Framework for Implementation Research and Morgan's framework.
  • Phase 1: Qualitative focus groups to identify barriers/facilitators of POCUS for CVC confirmation.
  • Phase 2: Strategy development based on identified determinants.
  • Phase 3: Local implementation and assessment of Proctor's outcomes (adoption, deadoption, fidelity, penetration) in an observational study.

Main Results:

  • The study aims to demonstrate proof of concept for the DRAUP program.
  • Secondary outcomes include assessing the efficacy (time) and effectiveness (sensitivity, specificity) of POCUS for CVC confirmation.
  • This pilot study will provide novel data on concurrent implementation and deimplementation strategies.

Conclusions:

  • The DRAUP program offers a novel approach to substituting low-value imaging with POCUS for CVC confirmation.
  • This research will expand knowledge on implementation strategies for replacing unnecessary care in acute care settings.
  • The findings will inform future interventions aimed at optimizing healthcare utilization and reducing medical overuse.