Multicenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial protocol.
OBJECTIVE
Evidence-based practice recommendations abound, but implementation is often unstructured and poorly audited. We assessed the ability of a peer network to implement an evidence-based best practice protocol and to measure patient outcomes.


METHODS
Consensus definition of spontaneous breathing trial followed by implementation in eight academic medical centers.


METHODS
Six medical, two surgical, and two combined medical/surgical adult intensive care units among eight academic medical centers.


METHODS
Patients initiating mechanical ventilation through an endotracheal tube during a 12-wk interval formed the study population.


METHODS
Adoption and implementation of a common spontaneous breathing trial protocol across multiple intensive care units.


RESULTS
Seven hundred five patients had 3,486 safety screens for conducting a spontaneous breathing trial; 2072 (59%) patients failed the safety screen. Another 379 (11%) patients failed a 2-min tolerance screen and 1,122 (34%) patients had a full 30-120 min spontaneous breathing trial performed. Seventy percent of eligible patients were enrolled. Only 55% of passing spontaneous breathing trials resulted in liberation from mechanical ventilatory support before another spontaneous breathing trial was performed.


CONCLUSIONS
Peer networks can be effective in promoting and implementing evidence-based best practices. Implementation of a best practice (spontaneous breathing trial) may be necessary for, but by itself insufficient to achieve, consistent and timely liberation from ventilator support.
Robertson
T Elizabeth
TE
Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA. robertsont@wudosis.wustl.edu
Mann
Henry J
HJ
Hyzy
Robert
R
Rogers
Angela
A
Douglas
Ivor
I
Waxman
Aaron B
AB
Weinert
Craig
C
Alapat
Philip
P
Guntupalli
Kalpalatha K
KK
Buchman
Timothy G
TG
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial / Q000592:standards*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012680:Sensitivity and Specificity; D017749:Total Quality Management; D015300:Ventilator Weaning / Q000592:standards