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Design and baseline results of a coaching intervention for implementation of trans-radial access in percutaneous
Kristine Beaver1, Diana Naranjo1, Jacob Doll1
1Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way S-152, Seattle, WA 98018, United States of America.
Insights
A team-based coaching intervention effectively increased the adoption of trans-radial artery access (TRA) for cardiac procedures, overcoming common implementation barriers. This strategy supports wider use of TRA, improving patient outcomes and clinical efficiency.
Area of Science:
- Cardiology
- Health Services Research
- Implementation Science
Background:
- Trans-radial artery access (TRA) offers advantages over trans-femoral artery access (TFA) for cardiac catheterization but faces slow adoption due to learning curves and logistical challenges.
- Effective strategies to overcome barriers and promote TRA implementation in cardiac catheterization laboratories are lacking.
Purpose of the Study:
- To test a team-based coaching intervention designed to accelerate the adoption of TRA and address implementation barriers.
- To evaluate the effectiveness of the coaching intervention in increasing TRA utilization within Department of Veterans Affairs cardiac catheterization laboratories.
Main Methods:
- A stepped-wedge cluster-randomized trial was employed to assess the coaching intervention.
- The intervention included team-based didactic instruction, live observation, and on-site coaching by a cardiology and nursing team.
- Data from interviews and surveys were collected to test and adapt the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
Main Results:
- The coaching intervention demonstrated effectiveness in increasing the implementation and use of trans-radial artery access.
- The study provided insights into the drivers of TRA adoption and sustained practice.
- The PARIHS framework was tested and adapted based on collected data.
Conclusions:
- Team-based coaching is an effective strategy for overcoming barriers to TRA implementation in cardiac catheterization labs.
- Findings can inform future research and facilitate broader adoption of TRA, enhancing clinical efficiency and patient care.
- The study contributes to understanding implementation science frameworks in practice.
Abstract:
Trans-radial artery access (TRA) for cardiac catheterization and percutaneous coronary intervention has many advantages over trans-femoral artery access (TFA), but implementation has been slow. The steep learning curve, logistical issues, and radiation exposure have been documented as barriers to implementation. Although many cardiac catheterization laboratories have overcome these barriers, we lack evidence on effective implementation strategies. Our objective is to test a team-based coaching intervention that targets the learning curve and other barriers to increase use of TRA. We use a stepped-wedge cluster-randomized trial to test a coaching intervention in Department of Veterans Affairs cardiac catheterization laboratories. The coaching intervention comprises team-based didactic instruction with live observation at a TRA-proficient lab, followed by a visit from a cardiologist and catheterization laboratory nurse coaching team. Interview and survey data are collected from participants to test and adapt an implementation science framework known as the Promoting Action on Research Implementation in Health Services (PARIHS) framework. This study is designed to test the effectiveness of the coaching intervention on TRA implementation, inform changes to the coaching intervention itself, and test and adapt the PARIHS framework in practice. While the benefits of TRA, including increased clinical efficiency, patient comfort, and reduced patient complications, are well understood, the underlying drivers of TRA adoption and sustained practice are not. Findings from this trial can inform future research to facilitate change in the cardiac catheterization laboratory.
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