Normalizing daily awakening and breathing coordination at 15 heterogenous ICUs: a multicenter post-implementation...

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Healthcare Implementation Science

Background:

• High adherence to coordinated spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocols exists.
• Clinicians may retain unresolved questions impacting long-term practice normalization and sustainment.
• Identifying these persistent concerns is crucial for protocol longevity.

Purpose of the Study:

• To identify unresolved questions or concerns regarding the coordinated SAT/SBT (C-SAT/SBT) protocol.
• To assess clinician perceptions of acceptability and practice normalization six months post-implementation.

Main Methods:

• A cross-sectional survey was administered to 606 clinicians (physicians, APPs, nurses, RTs) across 12 hospitals.
• Evaluated clinician perceptions of C-SAT/SBT protocol acceptability (usefulness, ease of use, confidence).
• Assessed perceived practice normalization and identified subgroups with lower agreement.

Main Results:

• High adherence (83.1%) and perceived acceptability (72.1%-88.1%) were reported.
• Perceived practice normalization was high overall (82.0%), but 71% disagreed with at least one normalization statement.
• Subgroup analysis revealed variations in agreement by role and site, indicating potential disparities.

Conclusions:

• Unresolved questions persist for certain clinician subgroups despite high adherence and acceptability of the C-SAT/SBT protocol.
• The long-term impact on practice normalization and sustainment remains unclear.
• Targeted, late post-implementation strategies may be necessary to address concerns and ensure sustained practice.