Impact of a care bundle for patients with blunt chest injury (ChIP): a multicentre controlled implementation evaluation

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

doi:10.1371/journal.pone.0256027

Impact of a care bundle for patients with blunt chest injury (ChIP): a multicentre controlled implementation evaluation

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

^*Corresponding author for this work

Australian Institute of Health Innovation

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

TRIAL REGISTRATION: ANZCTR: ACTRN12618001548224, approved 17/09/2018.

Original language	English
Article number	e0256027
Pages (from-to)	1-15
Number of pages	15
Journal	PLoS ONE
Volume	16
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0256027
Publication status	Published - 7 Oct 2021

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Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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10.1371/journal.pone.0256027Licence: CC BY

Publisher version (open access)Final published version, 1.29 MBLicence: CC BY

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Curtis, K., Kourouche, S., Asha, S., Considine, J., Fry, M., Middleton, S., Mitchell, R., Munroe, B., Shaban, R. Z., D'Amato, A., Skinner, C., Wiseman, G., & Buckley, T. (2021). Impact of a care bundle for patients with blunt chest injury (ChIP): a multicentre controlled implementation evaluation. PLoS ONE, 16(10), 1-15. [e0256027]. https://doi.org/10.1371/journal.pone.0256027

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abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.TRIAL REGISTRATION: ANZCTR: ACTRN12618001548224, approved 17/09/2018.",

author = "Kate Curtis and Sarah Kourouche and Stephen Asha and Julie Considine and Margaret Fry and Sandy Middleton and Rebecca Mitchell and Belinda Munroe and Shaban, {Ramon Z.} and Alfa D'Amato and Clare Skinner and Glen Wiseman and Thomas Buckley",

note = "Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2021",

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Curtis, K, Kourouche, S, Asha, S, Considine, J, Fry, M, Middleton, S, Mitchell, R, Munroe, B, Shaban, RZ, D'Amato, A, Skinner, C, Wiseman, G & Buckley, T 2021, 'Impact of a care bundle for patients with blunt chest injury (ChIP): a multicentre controlled implementation evaluation', PLoS ONE, vol. 16, no. 10, e0256027, pp. 1-15. https://doi.org/10.1371/journal.pone.0256027

TY - JOUR

T1 - Impact of a care bundle for patients with blunt chest injury (ChIP)

T2 - a multicentre controlled implementation evaluation

AU - Curtis, Kate

AU - Kourouche, Sarah

AU - Asha, Stephen

AU - Considine, Julie

AU - Fry, Margaret

AU - Middleton, Sandy

AU - Mitchell, Rebecca

AU - Munroe, Belinda

AU - Shaban, Ramon Z.

AU - D'Amato, Alfa

AU - Skinner, Clare

AU - Wiseman, Glen

AU - Buckley, Thomas

N1 - Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2021/10/7

Y1 - 2021/10/7

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.TRIAL REGISTRATION: ANZCTR: ACTRN12618001548224, approved 17/09/2018.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.TRIAL REGISTRATION: ANZCTR: ACTRN12618001548224, approved 17/09/2018.

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DO - 10.1371/journal.pone.0256027

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SN - 1932-6203

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JO - PLoS ONE

JF - PLoS ONE

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ER -

Impact of a care bundle for patients with blunt chest injury (ChIP): a multicentre controlled implementation evaluation

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A multicentre controlled implementation evaluation of a blunt chest injury care bundle (ChIP)

Implementation evaluation of a blunt chest injury care bundle (ChIP)

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