Phase | Research question | Methods | Target population/data resource | Measures |
---|---|---|---|---|
A | What are the current practices (before-implementation) and the adherence to the delirium guideline in the participating ICUs? | Prospective, descriptive study, analyzing variation of care | Data from 6 ICUs | Indicators e.g.: |
??-Adherence to delirium screening | ||||
??-Incidence of delirium | ||||
??-Pharmacological treatment | ||||
??-Sedation practices | ||||
??-Non-pharmacological treatment | ||||
??-Knowledge | ||||
B | What are the influencing factors (barriers and facilitators) for the implementation of the Dutch ICU delirium guideline by intensivists, ICU nurses, and psychiatrists? | Survey on knowledge, attitudes and perceptions, and structured focus group interviews | Health care professionals: intensivists, residents, ICU nurses, managers and psychiatrists, geriatrist or neurologist | Barriers and facilitators classified as related to: 1) guideline; 2) provider characteristics (e.g. knowledge and attitudes); 3) institutional characteristics (e.g. organization, structure, resources); 4) implementation (e.g. how and to what extent the guideline is implemented); 5) patient characteristics; and 6) social context (e.g. ICU culture). |
C | What is the content of a tailored strategy to improve the adherence to the delirium guideline? | Strategy development according to implementation frameworks by Grol and Wensing, and Cabana | Matching the data from the current practice, questionnaires and focus groups and questionnaires to construct effective implementation strategies from the literature | Tailored multifaceted implementation strategy to effectively implement current guideline based delirium management |
D | What is the effect of the tailored implementation strategy on guideline adherence, knowledge of health care providers, delirium incidence, clinical outcomes (mortality, length of stay) and health care costs? | Prospective before-after study | Data from 6 ICUs | (Process) indicators e.g.: |
-Adherence delirium screening | ||||
-Incidence of delirium | ||||
-Pharmacological treatment | ||||
-Non-pharmacological treatment | ||||
-Knowledge | ||||
Outcomes e.g.: | ||||
-Length of stay | ||||
-Hospital mortality | ||||
Costs | ||||
D | Explore potential explanations for why the intervention was effective or not based on ICU and health care providers' characteristics indicative of local ‘culture’. | Process evaluation: qualitative (outcomes,) and quantitative data (survey and interviews) | Data from 6 ICUs. Frame work for process evaluation, matching outcomes with actual exposure, and experiences of the implementation strategy | Underlying mechanisms that explain the effects of the study. |