Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

BMJ Quality & Safety
Vikas N O'Reilly-ShahGrant C Lynde

Abstract

Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system. Dashboards were emailed to providers four times over the course of the 9-month study. Additionally, the default setting on anaesthesia machines for tidal volume was decreased from 700 mL to 400 mL. Data on surgical cases performed between 1 September 2016 and 31 May 2017 were examined for compliance with LPV. The impact of the interventions was assessed via pairwise logistic regression analysis corrected for multiple comparisons. A total of 14 793 anaesthesia records were analysed. Absolute compliance rates increased from 59.3% to 87.8%preinterve...Continue Reading

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Citations

Apr 29, 2020·Journal of Evaluation in Clinical Practice·Klay LamprellJeffrey Braithwaite
Jun 13, 2020·Current Opinion in Anaesthesiology·Christina A JellyRobert E Freundlich
May 19, 2021·BMJ Quality & Safety·Robert E Burke, Perla J Marang-van de Mheen
Jun 4, 2021·BMC Health Services Research·Anita Sant'AnnaAxel Wolf
Jul 14, 2021·BMJ Open·Briana S LastRinad S Beidas
Aug 14, 2021·International Anesthesiology Clinics·Molly B KrausNatalie H Strand

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