Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study
Objectives Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extuba...
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/8/e045674.full |
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| author | Tim Ramsay Andrew JE Seely Karen EA Burns Aimee J Sarti Katina Zheng Stephanie Sutherland Rebecca Porteous Irene Watpool Christophe L Herry Michael Hickey Nathan B Scales Caitlin Anstee Anna Fazekas |
| author_facet | Tim Ramsay Andrew JE Seely Karen EA Burns Aimee J Sarti Katina Zheng Stephanie Sutherland Rebecca Porteous Irene Watpool Christophe L Herry Michael Hickey Nathan B Scales Caitlin Anstee Anna Fazekas |
| author_sort | Tim Ramsay |
| collection | DOAJ |
| description | Objectives Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extubation decision support (CDS) tool.Design Phase I mixed-methods observational study.Setting Two Canadian intensive care units (ICUs).Participants We included patients on mechanical ventilation for ≥24 hours and clinicians (respiratory therapists and intensivists) responsible for extubation decisions.Interventions Components included a predictive model assessment, feasibility evaluation, questionnaires and interviews with clinicians.Results We enrolled 117 patients, totalling 151 SBTs and 80 extubations. The incidence of extubation failure was 11% in low-risk patients and 21% in high-risk patients stratified by the predictive model; 38% failed extubation when both the model and clinical impression were at high risk. The tool was well rated: 94% and 75% rated the data entry and EA report as average or better, respectively. Interviews (n=15) revealed favourable impressions regarding its user interface and functionality, but unexpectedly, also concerns regarding EA’s potential impact on respiratory therapists’ job security.Conclusions EA implementation was feasible, and users perceived it to have potential to support extubation decision-making. This study helps to understand bedside implementation of CDS tools in a multidisciplinary ICU.Trial registration number NCT02988167. |
| format | Article |
| id | doaj-art-1bd9f0a052e045b19fcb53552ef31af6 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1bd9f0a052e045b19fcb53552ef31af62025-08-20T02:34:00ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2020-045674Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational studyTim Ramsay0Andrew JE Seely1Karen EA Burns2Aimee J Sarti3Katina Zheng4Stephanie Sutherland5Rebecca Porteous6Irene Watpool7Christophe L Herry8Michael Hickey9Nathan B Scales10Caitlin Anstee11Anna Fazekas12Ottawa Hospital Research Institute, Ottawa, Ontario, Canada7 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada11 Interdepartmental Division of Critical Care and the Li Ka Shing Knowledge Institute, St. Michael`s Hospital, Toronto, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaDivision of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDepartment of Critical Care, Ottawa Hospital, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaObjectives Although spontaneous breathing trials (SBTs) are standard of care to extubation readiness, no tool exists that optimises prediction and standardises assessment. In this study, we evaluated the feasibility and clinical impressions of Extubation Advisor (EA), a comprehensive clinical extubation decision support (CDS) tool.Design Phase I mixed-methods observational study.Setting Two Canadian intensive care units (ICUs).Participants We included patients on mechanical ventilation for ≥24 hours and clinicians (respiratory therapists and intensivists) responsible for extubation decisions.Interventions Components included a predictive model assessment, feasibility evaluation, questionnaires and interviews with clinicians.Results We enrolled 117 patients, totalling 151 SBTs and 80 extubations. The incidence of extubation failure was 11% in low-risk patients and 21% in high-risk patients stratified by the predictive model; 38% failed extubation when both the model and clinical impression were at high risk. The tool was well rated: 94% and 75% rated the data entry and EA report as average or better, respectively. Interviews (n=15) revealed favourable impressions regarding its user interface and functionality, but unexpectedly, also concerns regarding EA’s potential impact on respiratory therapists’ job security.Conclusions EA implementation was feasible, and users perceived it to have potential to support extubation decision-making. This study helps to understand bedside implementation of CDS tools in a multidisciplinary ICU.Trial registration number NCT02988167.https://bmjopen.bmj.com/content/11/8/e045674.full |
| spellingShingle | Tim Ramsay Andrew JE Seely Karen EA Burns Aimee J Sarti Katina Zheng Stephanie Sutherland Rebecca Porteous Irene Watpool Christophe L Herry Michael Hickey Nathan B Scales Caitlin Anstee Anna Fazekas Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study BMJ Open |
| title | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
| title_full | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
| title_fullStr | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
| title_full_unstemmed | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
| title_short | Feasibility of implementing Extubation Advisor, a clinical decision support tool to improve extubation decision-making in the ICU: a mixed-methods observational study |
| title_sort | feasibility of implementing extubation advisor a clinical decision support tool to improve extubation decision making in the icu a mixed methods observational study |
| url | https://bmjopen.bmj.com/content/11/8/e045674.full |
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