suddicu project - crit care symposium · suddicu project suddicu project launch june 7th 2010 ....

HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The author accepts full responsibility for this talk.

Health Services Research Unit University of Aberdeen

SuDDICU Project

SuDDICU Project Launch

June 7th 2010

Health Services Research Unit

What ‘s the SuDDICU project again?

Brief overview


Background

• The Problem: • Hospital Acquired Infections

(HAIs) are major clinical problem.

• HAIs have severe consequences in ICU patients.

• The Procedure: • Selective Decontamination of the

Digestive (SDD) tract is used to prevent HAIs and mortality.

• SDD is the application of topical non-absorbable antibiotics to the throat and stomach and a short course of intravenous antibiotics.


Background

• The Evidence: • Effectiveness: Meta-analyses show that SDD is effective in

reducing HAIs and, in some cases, mortality.

• Implementation: Despite favourable evidence, SDD is not used frequently – 10-15 ICUs in the UK.

• Potential Issues: • SDD too complex

• behavioural problem

• SDD evidence inadequate • e.g. not generalisable, gaps in intervention designs

• SDD counterintuitive • fear of multi-resistant organisms


Research Questions

1. What are the clinical and behavioural components of SDD?

2. How has SDD been implemented and delivered into practice?

3. What are stakeholders’ views on consequences of SDD?

4. What are stakeholders’ views on barriers to implementing SDD?

5. What are stakeholders’ views on validity & adequacy of evidence?

6. What are the current SDD practices and intentions of intensivists & microbiologists?

7. If there are uncertainties in the evidence base, what trial design(s) and interventions would be preferred to address these?

8. What are the likely challenges in a large multi-national RCT of SDD?


September 2011 – November 2011

Complete by August 2010

SuDDICU Overview

CASE STUDIES OF UNITS DELIVERING SDD

DELPHI STUDY OF KEY STAKEHOLDERS’ SDD BELIEFS

NATIONWIDE SURVEY OF CURRENT SDD PRACTICE AND BELIEFS

SEMI-STRUCTURED INTERVIEWS WITH INTENSIVE CARE TRIALISTS STAGE 4

STAGE 3

STAGE 2

STAGE 1

1. What are the clinical and behavioural components of SDD?

2. How has SDD been implemented and delivered into practice?

3. What are stakeholders’ views on consequences of SDD?

4. What are stakeholders’ views on barriers to implementing SDD?

5. What are stakeholders’ views on validity & adequacy of evidence?

6. What are the current SDD practices and intentions of intensivists & microbiologists?

7. If there are uncertainties in the evidence base, what trial design(s) and interventions would be preferred to address these?

8. What are the likely challenges in a large multi-national RCT of SDD?

June 2010 - August 2011

April 2011 – September 2011


Stage 1: Case Studies

• Design: Observational and interview study

• Procedures: • Observation of SDD delivery

• Interviews with stakeholders

• Sample: • Clinical lead

• Microbiologist

• Pharmacist

• ICU nurse

• Outcomes: • Behavioural observation,

• Interview responses,

• SDD relevant materials and documents

2 ICUs currently delivering SDD

involved in SDD implementation and/or delivery

Target n = 2 each



• Analysis:

• Behavioural Analysis of Complex Clinical Procedure

Person 1 Person 2 Person 3 Person 4

Time 1 Action 1

Time 2 Action 2, 3, 4

Time 3 Action 5, 6, 7

Time 4 Action 8 Action 9, 10 Action 11



• Analysis:

• Behavioural Analysis of Complex Clinical Procedure

Doctor Pharmacist ICU nurse Microbiologist

SDD decision Selects patient

Pre delivery Orders and prepares

antibiotics

SDD delivery Pick up drugs,

administer SDD

Post delivery Monitoring of

antibiotics stocks

Disposes of

leftovers

Monitor ICU

environment


Delphi

• Goals of the Delphi interview:

• Access diverse (rather than representative) expert opinions/beliefs on SDD

• Develop a questionnaire that includes the key issues and opinions to be able to assess representative in the next stage of the project (i.e. Stage 3: Nationwide Questionnaire Study).

• Tap into relevant theoretical domains for three specific behaviours:

1. Providing SDD

2. Participating in an effectiveness trial

3. Participating in an implementation trial


Theory

Skills

Social/Role Identity

Beliefs about capabilities

Environmental context and resources

Behavioural regulation

Emotion Social

influences

Memory, attention and

decision processes

Motivation and goals

Beliefs about consequences

Knowledge

Michie et al., 2005


Stage 2: Delphi Survey

• Design: • 4 Delphi ‘rounds’

• Procedures: 1. Semi-structured one-to-one telephone interviews

2. Feedback on interviews via email questionnaire

3. Feedback and revisions via email questionnaire

4. International feedback and revisions via email questionnaire

• Sample: • Clinical lead

• Microbiologist

• Pharmacist

• ICU nurse

stakeholders involved in SDD implementation and/or delivery

Target n = 10 each


Stage 3: Nationwide Survey

• Design:

• Nationwide survey (based on responses from Delphi)

• Sample: • Clinical leads (n~2000)

• Microbiologists (n~180)

• Procedures: • One large-scale postal questionnaire

• Analysis: • descriptive statistical methods

• statistical prediction techniques


Stage 4: Trialists interviews

• Design:

• Semi-structured interviews

• Sample:

• International trialists (published authors of large randomised trials in critical care, target n = 10)

• Procedures: • One-to-one telephone administered interview

• Analysis: • Transcripts analysed using content analysis


What ‘s the funding situation?

Funding update


SuDDICU International

SuDDICU protocol adopted in 3 countries:

1. UK

2. Canada

3. Australia/New Zealand


Team

The

Geoff Bellingan University College London, UK

Marion Campbell University of Aberdeen, UK

Brian Cuthbertson Sunnybrook Health Sciences Centre, Canada

Stephan Dombrowski University of Aberdeen, UK

Martin Eccles Newcastle University, UK

Jill Francis University of Aberdeen, UK

Marie Johnston University of Aberdeen, UK

Graeme MacLennan University of Aberdeen, UK

Craig Ramsey University of Aberdeen, UK

Louise Rose University of Toronto, Canada

Kathy Rowan Intensive Care National Audit & Research Centre, UK

Ian Seppelt University of Sydney, Australia

Rob Shulman University College Hospital, UK

Peter Wilson University College Hospital, UK


Any questions?

Additional feedback, thoughts, or comments please email Stephan: [email protected]

Thank you

suddicu project - crit care symposium · suddicu project suddicu project launch june 7th 2010 ....

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