Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation

Kate Curtis; Sarah Kourouche; Stephen Asha; Julie Considine; Margaret Fry; Sandy Middleton; Rebecca Mitchell; Belinda Munroe; Ramon Z Shaban; Alfa D'Amato; Clare Skinner; Glen Wiseman; Thomas Buckley

doi:10.1371/journal.pone.0256027

Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation

PLoS One. 2021 Oct 7;16(10):e0256027. doi: 10.1371/journal.pone.0256027. eCollection 2021.

Authors

Kate Curtis^{1

2

3}, Sarah Kourouche¹, Stephen Asha^{4

5}, Julie Considine^{6

7}, Margaret Fry^{1

8

9}, Sandy Middleton^{10

11}, Rebecca Mitchell¹², Belinda Munroe^{1

2}, Ramon Z Shaban^{1

13

14

15}, Alfa D'Amato¹⁶, Clare Skinner¹⁷, Glen Wiseman¹⁸, Thomas Buckley¹

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
² Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia.
³ Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
⁴ Emergency Department, St George Hospital, Kogarah, NSW, Australia.
⁵ St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia.
⁶ School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
⁷ Centre for Quality and Patient Safety Experience-Eastern Health Partnership, Box Hill, VIC, Australia.
⁸ Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
⁹ Northern Sydney Local Health District, Hornsby, NSW, Australia.
¹⁰ Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Fitzroy, Australia.
¹¹ Australian Catholic University, Sydney, NSW, Australia.
¹² Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia.
¹³ Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia.
¹⁴ Division of Infectious Diseases and Sexual Health, Department of Infection Prevention and Control, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia.
¹⁵ New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Warwick Farm, NSW, Australia.
¹⁶ NSW Activity Based Funding Taskforce, NSW Ministry of Health, Sydney, Australia.
¹⁷ Emergency Department, Hornsby Ku-ring-ai Hospital, Hornsby, NSW, Australia.
¹⁸ Emergency Services, Canterbury Hospital, Campsie, NSW, Australia.

Abstract

Background: Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury-respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel.

Methods: This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality.

Results: There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18-0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04-0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61-9.45), physiotherapy OR 2.17 (95% CI 1.52-3.11), ICU doctor OR 6.13 (95% CI 3.94-9.55), ICU liaison OR 55.75 (95% CI 17.48-177.75), pain team OR 8.15 (95% CI 5.52 --12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64-3.94) and regional analgesia OR 8.8 (95% CI 3.39-22.79), incentive spirometry OR 8.3 (95% CI 4.49-15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43-39.2) in the intervention group compared to the control group in the post- period.

Conclusion: The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement.

Trial registration: ANZCTR: ACTRN12618001548224, approved 17/09/2018.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Analgesia
Critical Care / methods*
Female
Humans
Male
Oxygen / administration & dosage
Pain Management
Patient Care Bundles / methods*
Physical Therapy Modalities
Respiratory Therapy
Ribs / injuries
Sternum / injuries
Thoracic Injuries / therapy*
Treatment Outcome
Wounds, Nonpenetrating / therapy*

Substances

Oxygen

Associated data

ANZCTR/ACTRN12618001548224

Grants and funding

This research has been supported by funding from the HCF Research Foundation Australia (KC, SA, JC, RM, RZS, MF, SM). SK was funded by a scholarship from the HCF Research Foundation (AU). High flow oxygenation machines were donated by Fisher and Paykel. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.