title: Navigating the institutional review board approval process in a multicenter observational critical care study.
abstract: OBJECTIVE
  To characterize variation in the institutional review board application process of a multicenter, observational critical care study.
  
  
  METHODS
  Survey analysis of 36 investigators who applied for participation in the United States Critical Illness and Injury Trials Group: Critical Illness and Outcomes Study, an observational study of 69 adult ICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Analysis of investigator-specific characteristics, institutional review board process, application and approval dates, and level of difficulty in obtaining approval. Surveys were analyzed from 36 sites (95%) that applied for institutional review board approval. Level of review ranged from full board, expedited, to exempt. Seventy-five percent of applications were submitted by an experienced investigator while 25% were submitted by a less experienced investigator. Median time to institutional review board approval was 30 days (interquartile range, 14-54) and ranged from 5 days to 5.5 months. Time to approval was 29 days (interquartile range, 17-48) for applications submitted by an experienced investigator compared with 97 days (interquartile range, 25-159) for those submitted by a less experienced investigator (p = 0.08). Subjective level of difficulty was significantly higher for less experienced investigators (4 of 10; interquartile range, 2-8) vs experienced investigators (2 of 10; interquartile range, 1-3) (p = 0.04). Four sites cited institutional review board concern regarding waiver of consent as a major barrier to approval and were required to perform revisions or participate in board meetings regarding this concern.
  
  
  CONCLUSIONS
  In a multicenter, observational critical care study, significant variation was observed between sites in all aspects of the institutional review board evaluation and approval process. The level of difficulty was significantly higher for less experienced investigators with a trend toward longer time to institutional review board approval. Variation in institutional review board interpretation of waiver of informed consent regulations was cited as a major barrier to approval.
authors.affiliation: 1Divison of Pulmonary and Critical Care Medicine, Emory University, Atlanta, GA. 2Division of Trauma, Critical Care and Emergency Surgery, University of Arizona, Tuscon, AZ. 3Departments of Medicine and Surgery, University of Maryland, Baltimore, MD. 4Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Polito
authors.forename: Sushma K
authors.initials: SK
authors.lastname: Cribbs
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Dan
authors.initials: D
authors.lastname: Herr
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sevransky
mesh_terms: D003422:Critical Care; D003625:Data Collection; D028744:Ethics Committees, Research / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent; D007362:Intensive Care Units; D015337:Multicenter Studies as Topic; D064887:Observational Studies as Topic; D012107:Research Design; D012108:Research Personnel / Q000706:statistics & numerical data*; D014481:United States