Acceptability of the Venting Wisely Pathway for use in Critically ill Adults with Hypoxemic Respiratory Failure and Acute Respiratory Distress Syndrome (ARDS): A qualitative study protocol
Bibliographic record
Abstract
ABSTRACT Introduction Hypoxemic respiratory failure (HRF) affects nearly 15% of critically ill adults admitted to an intensive care unit (ICU). An evidence based, stakeholder informed multidisciplinary care pathway ( Venting Wisely ) was created to standardize the diagnosis and management of patients with HRF and Acute Respiratory Distress Syndrome (ARDS). Successful adherence to the pathway requires a coordinated team-based approach by the clinician team. The overall aim of this study is to describe the acceptability of the Venting Wisely pathway among critical care clinicians. Specifically, this will allow us to: 1) better understand the user’s experience with the intervention and 2) determine if the intervention was delivered as intended. Methods and analysis This qualitative study will conduct focus groups with nurse practitioners, physicians, registered nurses, and registered respiratory therapists from 17 Alberta ICUs. We will use template analysis to describe the acceptability of a multi component care pathway according to seven constructs of acceptability: 1) Affective attitude; 2) Burden; 3) Ethicality; 4) Intervention coherence; 5) Opportunity costs; 6) Perceived effectiveness; and 7) Self-efficacy. This study will contribute to a better understanding of the acceptability of the Venting Wisely pathway. Identification of areas of poor acceptability will be used to refine the pathway and implementation strategies as ways to improve adherence to the pathway and promote its sustainability. Ethics and dissemination The study was approved by the University of Calgary Conjoint Health Research Ethics Board (CHREB). The results will be submitted for publication in a peer-reviewed journal and presented at a scientific conference. STRENGTHS AND LIMITATIONS This qualitative study will provide vital information about why the implementation of the Venting Wisely pathway may or may not have worked as anticipated. Findings will identify opportunities to improve pathway adherence and provide insights on how to sustain the intervention and scale to other sites. Acceptance and adherence of the Venting Wisely pathway has the potential to increase and standardize the use of evidence-informed, life-saving therapies for mechanically ventilated patients; this may improve outcomes and save costs to the healthcare system. Focus groups will be conducted with a wide variety of clinicians (nurse practitioners, physicians, registered nurses, registered respiratory therapists), and within various intensive care units (general systems, cardiovascular surgery, and neurosciences), and hospitals (regional, community, and tertiary). The study is being conducted in one province in Canada, which may limit generalizability.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.045 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.008 | 0.007 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".