Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation.
<h4>Background</h4>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 blun...
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2021
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oai:doaj.org-article:799be2a7c31a4cbd96e660b234f267d72021-12-02T20:13:48ZImpact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation.1932-620310.1371/journal.pone.0256027https://doaj.org/article/799be2a7c31a4cbd96e660b234f267d72021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256027https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Trial registration</h4>ANZCTR: ACTRN12618001548224, approved 17/09/2018.Kate CurtisSarah KouroucheStephen AshaJulie ConsidineMargaret FrySandy MiddletonRebecca MitchellBelinda MunroeRamon Z ShabanAlfa D'AmatoClare SkinnerGlen WisemanThomas BuckleyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0256027 (2021) |
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EN |
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Medicine R Science Q |
| spellingShingle |
Medicine R Science Q Kate Curtis Sarah Kourouche Stephen Asha Julie Considine Margaret Fry Sandy Middleton Rebecca Mitchell Belinda Munroe Ramon Z Shaban Alfa D'Amato Clare Skinner Glen Wiseman Thomas Buckley Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| description |
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Trial registration</h4>ANZCTR: ACTRN12618001548224, approved 17/09/2018. |
| format |
article |
| author |
Kate Curtis Sarah Kourouche Stephen Asha Julie Considine Margaret Fry Sandy Middleton Rebecca Mitchell Belinda Munroe Ramon Z Shaban Alfa D'Amato Clare Skinner Glen Wiseman Thomas Buckley |
| author_facet |
Kate Curtis Sarah Kourouche Stephen Asha Julie Considine Margaret Fry Sandy Middleton Rebecca Mitchell Belinda Munroe Ramon Z Shaban Alfa D'Amato Clare Skinner Glen Wiseman Thomas Buckley |
| author_sort |
Kate Curtis |
| title |
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| title_short |
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| title_full |
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| title_fullStr |
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| title_full_unstemmed |
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. |
| title_sort |
impact of a care bundle for patients with blunt chest injury (chip): a multicentre controlled implementation evaluation. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/799be2a7c31a4cbd96e660b234f267d7 |
| work_keys_str_mv |
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