A rapid pre-implementation evaluation to inform a family engagement navigator program during COVID-19

Stephanie Parks Taylor, Robert T Short 3rd, Anthony M Asher, Brice Taylor, Rinad S Beidas, Stephanie Parks Taylor, Robert T Short 3rd, Anthony M Asher, Brice Taylor, Rinad S Beidas

Abstract

Background: Innovative models of family engagement and support are needed in the intensive care unit (ICU) during times of restricted visitation such as the COVID-19 pandemic. Limited understanding of the factors affecting the uptake and outcomes of different family support models hinders the implementation of best practices. We aimed to conduct a rapid pre-implementation evaluation of stakeholder-perceived facilitators and barriers to design implementation strategies to support a novel program using medical students to facilitate family-centered care in the ICU.

Methods: We conducted a 2-step process. In step 1, we gathered contextual data via interview-style open-ended questions sent to clinicians and navigator stakeholders via email. We used electronic data collection due to the physical distancing requirements, the need to prioritize brief data collection for respondent burden, and the need for rapid knowledge gain. A codebook based on the Consolidated Framework for Implementation Research (CFIR), an integrated framework from the field of implementation science, was used to analyze the findings. In step 2, a pilot of the intervention was implemented with 3 navigators over 2 weeks. Implementation strategies were developed to target barriers identified by the pre-implementation evaluation.

Results: Fourteen (70%) of the identified stakeholders responded to the survey. Ten constructs encompassing all five CFIR domains were present in responses as implementation influencers, with the Intervention domain most frequently represented. Through these results and operational feedback from navigators during the pilot period, stakeholders selected multiple implementation strategies: audit and provide feedback, develop educational materials, conduct ongoing training, promote adaptability, assess and redesign workflow, identify and prepare champions, and engage community resources.

Conclusions: We demonstrated how a conceptually based pre-implementation program evaluation can be used to rapidly inform optimal implementation strategies. We report key factors to inform design and implementation strategies for a novel ICU family engagement navigator program that may be useful to others wishing to adopt similar programs.

Keywords: COVID-19; Critical care; Family engagement; Family-centered care; Rapid analysis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Core components for a successful family engagement navigator program and anticipated outcomes
Fig. 2
Fig. 2
Overview of the pre-implementation evaluation timeline

References

    1. Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103–128. doi: 10.1097/CCM.0000000000002169.
    1. Hart JL, Turnbull AE, Oppenheim IM, Courtright KR. Family-Centered Care During the COVID-19 Era. J Pain Symptom Manage. 2020;60(2):e93–e97.
    1. Griffin KM, Karas MG, Ivascu NS, Lief L. Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective. Am J Respir Crit Care Med. 2020;201(11):1337–44.
    1. Papadimos TJ, Marcolini EG, Hadian M, et al. Ethics of outbreaks position statement. Part 2: Family-centered care. Crit Care Med. 2018;46:1856–1860. doi: 10.1097/CCM.0000000000003363.
    1. PAIR - COVID-19 resources. . Published 2020. Accessed 4 May 2020.
    1. Curtis JR, Treece PD, Nielsen EL, et al. Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med. 2016;193:154–162. doi: 10.1164/rccm.201505-0900OC.
    1. White DB, Angus DA, Shields AM, et al. A randomized trial of a family-support intervention in intensive care units. NEJM. 2018;378:2365–2375. doi: 10.1056/NEJMoa1802637.
    1. Wensing M, Sales A, Armstrong R, et al. Implementation science in times of Covid-19. Implement Sci. 2020;15:42. doi: 10.1186/s13012-020-01006-x.
    1. Featherstone RM, Dryden DM, Foisy M, Guise JM, Mitchell MD, Paynter RA, Robinson KA, Umscheid CA, Hartling L. Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews. Syst Rev. 2015;4(1):50. doi: 10.1186/s13643-015-0040-4.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Hoffmann Tammy C, Glasziou Paul P, Isabelle B, Ruairidh M, Rafael P, David M, et al. Better reporting of interventions: Template for Intervention Description and Replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. doi: 10.1136/bmj.g1687.
    1. Harris PA, Taylor R, Minor BL, et al. The REDCap Consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi: 10.1016/j.jbi.2019.103208.
    1. Brehaut JC, Eva KW. Building theories of knowledge translation interventions: use the entire menu of constructs. Implement Sci. 2012;7:114. doi: 10.1186/1748-5908-7-114.
    1. Consolidated framework for implementation research guide. Published 2020. Accessed 16 Jul 2020.
    1. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21. doi: 10.1186/s13012-015-0209-1.
    1. Harris FM, Maxwell M, O’Connor RC, et al. Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries. BMC Public Health. 2013;13(1):158. doi: 10.1186/1471-2458-13-158.
    1. Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Miech EJ, Rattray NA, Flanagan ME, Damschroder L, Schmid AA, Damush TM. Inside help: an integrative review of champions in healthcare-related implementation. SAGE Open Med. 2018;6:205. doi: 10.1177/2050312118773261.
    1. Taylor SP, Short RT, Asher AM, Muthukkmar R, Sanka P. Family engagement navigators: a novel program to facilitate family-centered care in the intensive care unit during Covid-19. NEJM Catalyst, Published online September 15, 2020.
    1. Patton MQ. Qualitative research and evaluation methods. Thousand Oaks: 3rd Sage Publications; 2002.
    1. Gale RC, Wu J, Erhardt T, et al. Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implementation Sci. 2019;14:11. doi: 10.1186/s13012-019-0853-y.
    1. Jones AH, Jacobs MB, October TW. Communication skills and practices vary by clinician type. Hosp Pediatr. 2020;10(4):325–330. doi: 10.1542/hpeds.2019-0262.

Source: PubMed

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