Deimplementing CXR After CVC (DRAUP) in the ICU

Adapting and Testing a Deimplementation Program in the Intensive Care Unit

This study proposes adapting and testing an innovative, behavioral theory-driven deimplementation program called DRAUP in two intensive care units for proof of concept and support that the program can help providers and hospital organizations address context determinants of deimplementation. Study data will be used to optimize the intervention for a subsequent larger trials.

Study Overview

• Status: Completed
• Conditions: Implementation Science; Behavior and Behavior Mechanisms
• Intervention / Treatment: Behavioral: adapted DRAUP strategy bundle

Detailed Description

There are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. Previously, we developed and initiated a successful evidence-based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We now move to adapt the deimplementation bundle in the new environment of the Intensive Care Unit (ICU) with hopeful continued success.

In experiment 1, qualitative analysis will be employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit and implementation outcomes as well as cost will be evaluated. In experiment 3, mixed methods will be used to evaluate the mechanism of impact of the refined program in the new environment.

• Study Type: Interventional
• Enrollment (Actual): 101
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St Louis, Missouri, United States, 63108
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Study Population

Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs DRAUP training: ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners

critically ill patients receiving a CVC

Description

-Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs

Inclusion Criteria for DRAUP training:

(1) ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners

• ICU inclusion for DRAUP program:
• Availability of ultrasound machines with archiving capability (DICOM)
• A minimum of 100 supradiaphragmatic CVC insertions annually in adult patients (age >18)
• Capacity to access digital archiving (PICOM)
• Patient inclusion for DRAUP program:
• supradiaphragmatic CVC placed
• Patient exclusion for DRAUP program:
• severe instability (cardiac arrest, severe shock) where CVC would be used without CXR,
• level 1 trauma;
• burn patients with no viable skin surface for imaging

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CVC confirmed by DRAUP; new mode of CVC confirmation for correct location and excluding pneumothorax	Behavioral: adapted DRAUP strategy bundle; DRAUP deimplementation strategy bundle includes: 1) education and training, 2) supervision and in-person decision support, and 3) audit and feedback to target capability. Opportunity is addressed by 4) algorithm development and 5) organizational support. Finally, 6) facilitators and 7) planned adaptation after interval program assessment address the motivations needed to change behavior.
Experimental: CVC confirmed by CXR; traditional mode of CVC confirmation for correct location and excluding pneumothorax	Behavioral: adapted DRAUP strategy bundle; DRAUP deimplementation strategy bundle includes: 1) education and training, 2) supervision and in-person decision support, and 3) audit and feedback to target capability. Opportunity is addressed by 4) algorithm development and 5) organizational support. Finally, 6) facilitators and 7) planned adaptation after interval program assessment address the motivations needed to change behavior.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
DRAUP in	Deadoption of CXR after US guided CVC confirmation	24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fidelity	Percentage of DRAUP non-adherence	24 months

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI)
• Investigators: Principal Investigator: Enyo Ablordeppey, MD MPH, Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): December 31, 2025

Study Registration Dates

• First Submitted: November 17, 2023
• First Submitted That Met QC Criteria: November 17, 2023
• First Posted (Actual): November 24, 2023

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 17, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavior
• Other Study ID Numbers: 202312113; 5K01HL161026-02 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD sharing upon request
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No