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Clinical Trial Details — Status: Enrolling by invitation

Administrative data

NCT number NCT05231200
Other study ID # 21-1336
Secondary ID 462647
Status Enrolling by invitation
Phase N/A
First received
Last updated
Start date May 1, 2023
Est. completion date August 30, 2027

Study information

Verified date January 2024
Source University of Calgary
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The ABC-QI Trial aims to implement collaborative quality improvement (QI) strategies to standardize care for 32-36 week infants in Level 2 and 3 Neonatal intensive care units (NICUs) across the province of Alberta. The investigators want to know if using validated quality improvement methods and evidence-based care bundles will decrease the duration of hospital stay and get babies home as quickly as possible.


Description:

A stepped-wedge cluster randomized trial will be conducted in 12 NICUs across Alberta (10 Level II and 2 Level III). Each NICU is considered a cluster and will be randomized to transition to the intervention arm at one of three time points. The planned trial interventions include: Intervention arm (Collaborative QI Strategies): The study intervention is a constellation of collaborative QI strategies: 1) QI Team Building; 2) QI Education; 3) Implementation of 2 standardized practice care bundles (Respiratory Care, and Nutritional Care); 4) QI mentoring; and 5) Collaborative networking. Based on the randomization, 4 NICUs will transition to the intervention arm at the end of each year. Control arm (current management): All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above.


Recruitment information / eligibility

Status Enrolling by invitation
Enrollment 9500
Est. completion date August 30, 2027
Est. primary completion date August 30, 2027
Accepts healthy volunteers No
Gender All
Age group 32 Weeks to 36 Weeks
Eligibility Inclusion Criteria: Preterm Infants: Infants born at 32 to 36 weeks' gestation and admitted to the participating NICUs or postpartum units. Quality Improvement Implementation Survey version 2 (QIIS-II) and semi-structured interview participants: Management staff, nurses, nurse practitioners, physicians, and allied health staff employed in participating NICUs. Exclusion Criteria: - Preterm Infants: - Major congenital anomalies or chromosomal abnormalities. - Primary admission to a surgical NICU: Alberta Children's Hospital or Stollery Children's Hospital. - Infants born in or transferred to a NICU outside Alberta.

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
QI Team Building
Each NICU will create a core QI team composed of 6-8 multidisciplinary members including a parent advisor, when feasible. This team will lead the QI activities and education, and champion the culture and practice change in the unit.
QI education
Each NICU QI team will receive standardized QI education using the 6-hour EPIQ Workshop which involves hands-on approach to enable teams to successfully implement QI projects together. EPIQ 10 Steps and QI Tools will be used to build the team's understanding of QI using realistic improvement opportunities based on the standardized care bundles identified in the trial.
Other:
Standardized care bundle- respiratory care
A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for stabilization and respiratory care in moderate and late preterm infants (MLPIs) including establishing effective ventilation in the delivery room prevention of hypothermia early diagnosis and management of respiratory distress with continuous positive airway pressure (CPAP) standardized approach for surfactant indications and administration standardized approach for early extubation.
Standardized care bundle- nutritional care
A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for nutritional support in MLPIs including early initiation of enteral or parenteral nutrition; standardized tables for feeding initiation and progression optimizing breastfeeding and use of mother's own milk standardized approach for a transition from enteral nutrition via tube feeds to oral feeds.
Behavioral:
QI mentoring
Each NICU in the intervention arm will have one or more assigned members of the study team who are experienced in collaborative QI and EPIQ methods. The mentors will help local QI teams to engage frontline staff in QI and navigate the unit-specific challenges.
Collaborative networking
The study team will conduct virtual meetings every 2 months for the NICUs in intervention arm allowing local QI teams to discuss progress, and share data. The investigators will arrange annual in-person or virtual meetings for the NICUs in the intervention arm to present projects, successes, and lessons learned. These NICUs will have continuing access to the data and will receive quarterly reports using statistical process control charts outlining the unit's performance compared to other units and to the group average.
Other:
Current practice- standard of care
All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above until they transition to the intervention arm. The investigators will capture these activities and account for them in the analysis.

Locations

Country Name City State
Canada Foothills Medical Centre Calgary Alberta

Sponsors (4)

Lead Sponsor Collaborator
University of Calgary Alberta Health services, Covenant Health, University of Alberta

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Length of Stay The duration of hospitalization until final discharge. Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Cost to healthcare system per participant The investigators will use the Canadian Institute for Health Information Patient Cost Estimator to calculate the daily cost based on the Case Mix Groups for gestational age and birth weight. Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Number of participants with Hypothermia Axillary temperature <36.5°C. Within 1 hour of birth
Secondary Number of participants with Hypoglycemia Blood glucose <2.6 mmol/L. First 24 hours of age
Secondary Surfactant administration Date and method of administration First 168 hours of age.
Secondary Duration of respiratory support Total number of days administered Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Age at achieving full enteral feeding Date when the enteral intake reaches 120 ml/kg/day. Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Time to regain birth weight Difference in days between birth date and date when the infants regains or exceeds birth weight after initial weight loss. Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Weight in grams actual values in grams At discharge home in survivors, assessed up to a corrected age of 6 months (6 months after their birth due date).
Secondary Length in centimeters actual values in centimeters At discharge home in survivors, assessed up to a corrected age of 6 months (6 months after their birth due date).
Secondary Head circumference in centimeters actual values in centimeters At discharge home in survivors, assessed up to a corrected age of 6 months (6 months after their birth due date).
Secondary Breastmilk use Defined as number of feeds where infant received breastfeeding or maternal expressed breastmilk Birth until discharge home or death, whichever came first, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Number of unplanned rehospitalizations per participant Unplanned readmission to any hospital in Alberta following discharge Within 30 days after discharge home
Secondary Number of emergency room visits per participant Emergency room visits to any hospital in Alberta following discharge Within 30 days after discharge home
Secondary Hospital mortality Proportion of infants who dies before first discharge home Until first discharge home, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Infant mortality before 1 year of corrected age Corrected age = chronological age - days required for an infant to complete postmenstrual age of 40 weeks. Before 1 year of corrected age
Secondary Transfer from Level II to Level III NICU Proportion of infants who require escalation of care and transfer to Level III NICU. Until first discharge home, assessed until the participant reaches a corrected age of 6 months (6 months after their birth due date).
Secondary Staff perception of collaborative QI (EPIQ) implementation. Semi-structured interviews with selected sample of staff from each NICU Year 2, 3, and 4 of study
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