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• W3204243266 abstract "Background: Despite high-quality evidence of a mortality benefit from low tidal volume ventilation (LTVV), many patients with acute respiratory distress syndrome do not receive LTVV. We developed a respiratory therapist (RT)-directed strategy in the electronic health record (EHR) based on behavioral economics. In this pilot study, our objective was to obtain RTs’ perceptions about the strategy and the process of determining tidal volume settings generally. Methods: We performed a two-phase pilot test as part of an NIH-funded, IRB-approved randomized trial in one cardiac care unit (CCU). The strategy employed an accountable justification alert, which required documentation of a reason in a free-text field if an RT recorded a set tidal volume greater than 6.5 cc/kg PBW. We implemented the alert for one month during each phase, making modifications based on iterative feedback. During both phases we conducted semi-structured interviews with RTs. We performed content analysis to identify perceptions of the alert and mechanical ventilation (MV) management. Results: The alert fired 62 times on 12 patients and for 27 RTs, and 31 times on 14 patients for 24 RTs during phases 1 and 2, respectively. In response to the nudges, RTs commonly dismissed the alert without completing it in phase 1. Based on these results, we modified the alert to require a response in order to proceed in the EHR. Prior to phase 2, we increased educational efforts with daily outreach to staff RTs during implementation. Common reasons provided for not using LTVV during phase 2 included that the patient did not have ARDS, that a higher tidal volume was prescribed, and that the patient was asynchronous. RTs generally viewed the nudge as favorable and unobtrusive to workflow, describing it as easy to use and fantastic. They felt the alert was a useful reminder and may help them advocate for patients during disagreements about LTVV use. RTs viewed use of LTVV as beneficial for patients but recognized its inconsistent use among physicians and throughout different ICUs. While RTs generally agreed that physicians made the final decisions regarding MV settings, they also felt they were able to advocate for patients and had autonomy when managing MV. Conclusions: Iterative pilot-testing of a nudge strategy to promote use of low tidal volumes proved useful to improve RT interactions with the nudge. The alert was viewed as useful and acceptable by RTs and has potential to improve evidence-based delivery of low tidal volume ventilation." @default.
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• W3204243266 date "2021-10-01" @default.
• W3204243266 modified "2023-09-26" @default.
• W3204243266 title "Electronic Health Record-Based Nudges to Promote the Use of Low Tidal Volumes" @default.
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