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Social Media for ImpLementing Evidence (SMILE): A Conceptual Framework

Submitted by:

Junqiang (John) Zhao

Email:

jzhao126@uottawa.ca

Author(s)

Junqiang Zhao, Gillian Harvey, Amanda Vandyk, Wendy Gifford

Institution of primary author:

School of Nursing, Faculty of Health Sciences, University of Ottawa

Background:

Social media has become widely used by individual researchers and professional organizations to translate research evidence to healthcare practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to impact research use.

Purpose:

The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for healthcare providers, policy makers, and/or patients to inform their healthcare decision making.

Method:

We developed this framework using an integrative approach that first involved reviewing five longstanding social media initiatives. We then drafted the initial framework using a deductive approach by referring to five theories on social media studies and knowledge translation. Fifty-eight empirical studies on factors that influenced the use of social media and its messages, and strategies to promote the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework.

Results:

The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision making, the framework proposes that social media content developers respond to their target recipients’ needs and context, and develop relevant messages and appropriate delivery strategies. Recipients’ use of social media messages are influenced by the virtual-technical, individual, organizational, and system contexts, and are activated by three types of triggers: sparks, facilitators, and signals. 

Conclusion:

The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients, and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in healthcare decision making. Empirical studies are now needed to test the propositions of this framework.

Junqiang Zhao

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Development and implementation of a prescriber checklist and reference guide for mifepristone medication abortion

Submitted by:

Kate Wahl

Email:

kate.wahl@cw.bc.ca

Author(s)

Kate Wahl, Wendy Norman, Ariane Wylie, Kristen Van Esch, Aleyah Williams, Sheila Dunn, Édith Guilbert, Sarah Munro

Institution of primary author:

University of British Columbia

Background:

In 2017, mifepristone medical abortion was introduced in Canada. To support uptake of this gold-standard practice into primary care, we developed and implemented a charting checklist and quick reference guide to support health care providers to offer medial abortion care. 

Methods:

The preliminary checklist and reference guide were adapted from 7 clinical exemplars using the 2016 Society of Obstetricians and Gynaecologists of Canada guidelines on medical abortion. Materials were subjected to expert review (n=6). Front-line providers (n=5) gave feedback on the revised materials in ‘think-aloud’ interviews and rated the materials using the System Usability Scale (SUS). Final materials were approved by expert reviewers; English and French versions were shared with providers through communities of practice convened online and in person. 

Results:

Expert reviewers were 4 clinician-researchers, 1 community stakeholder, and 1 knowledge translation scientist. Front-line participants were 2 family physicians, 1 obstetrician-gynaecologist, 1 family medicine resident, and 1 registered nurse. Front-line participants had between 2 and 20+ years in practice; 3 had previous experience with medication abortion and 2 did not. Changes to the materials focused on alignment with clinical guidelines and best practices as well as suitability for the clinical context. The median SUS was 86.25 (69.4-97.5), indicating good-to-excellent usability, Between April 2018 and October 2021, the resources were downloaded 5,704 times, including a marked increase in downloads following the outbreak of the COVID-19 pandemic. 

Conclusions:

Many Canadian health care providers are adding medication abortion to their scope of practice for the first time. The tools described above are supporting the implementation of medical abortion services in the Canadian context. 

Kate Wahl Checklist poster

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Developing a patient-oriented tool for assessing the scalability of innovations in community-based primary health care in Canada

Submitted by:

Roberta de Carvalho Corôa

Email:

roberta.de-carvalho-coroa.1@ulaval.ca

Author(s)

Roberta de Carvalho Corôa France Légaré Léonel Philibert Sabrina Guay-Bélanger Karine Plourde

Institution of primary author:

Université Laval / VITAM - Centre de recherche en santé durable - CIUSSSCN

Background:

There is a gap between health innovations whose effectiveness can be demonstrated with evidence and those whose benefits are delivered to the population. In this way, evidenced-based interventions should be scaled up. Nevertheless, despite the existence of models and guides to encourage this practice, there is a lack of practical tools to assess the potential of an innovation to be scaled up (scalability). In this work, we aimed to present the steps we conduct to develop a patient-oriented tool for assessing the scalability of innovations in community-based primary health care in Canada (CBPHC). 

Methods:

Our tool is developed through the perspective of Integrated knowledge translation (IKT) and we follow the RAND/UCLA Appropriateness Method (RAM). We conducted a systematic review following the COSMIN methodology to identify tools proposed for assessing the scalability of innovations in health. An online Delphi (eDelphi) is in progress to achieve consensus and validate among experts and stakeholders the most pertinent items to assess the scalability components which were retrieved from the review and that will be included in our tool. First, two reviewers independently are selecting the eligible items by excluding the duplicates, merging the complementaries and applying sixteen interpretability criteria. Second, we will proceed with the snowball recruitment method from our research team’s network and ensure that 100 people will participate in the study. They will be patients or citizens representatives, family physicians, policy/decision makers, researchers and members of relevant SPOR and CBPHC Canadian organizations. Finally, the eDelphi will be conducted in three rounds, in which we will collect sociodemographic information from the participants and they will be asked to decide on the relevance of each item included in the preliminary list as well to suggest the inclusion of other item. Participants will use 0 to 10 score (0 = not relevant and 10 = highly relevant) and we will classify their responses as low (0-3), moderate (4-6) and high (7-9). In the end, we will calculate the averages and percentages and the consensus will be considered if there is an 80% agreement for the score of 7-9.

Results:

The knowledge synthesis identified 31 reports describing 21 tools to assess scalability. Tools contained a total of 320 items that were categorized through 12 scalability components. 

Conclusions:

The eDelphi will provide the expert opinion on the most promising criteria for assessing the scalability of evidence-based innovations in the context of CBPHC. The result expected is the validated version of the self-administered questionnaire to assess the scalability of innovations in CBPHC.

Roberta Coroa poster

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Characterizing health research partnerships in child health: a scoping review

Submitted by:

Leah K Crockett

Email:

umcrocke@myumanitoba.ca

Author(s)

Crockett LK, Scott SD, Driedger SM, Sibley KM

Institution of primary author:

University of Manitoba

Background:

Over the last two decades, research partnerships between health researchers and knowledge users (KUs) have advanced to bridge know-do gaps and promote more relevant, meaningful and impactful research. Research partnerships in child health are complex, as engagement often occurs with individuals on their behalf (e.g. parents and families) or with children and youth themselves, requiring attention to engagement strategies and principles. There remains a gap in our understanding of research partnerships in child health that includes the range of approaches used (e.g. integrated knowledge translation (iKT), community-based participatory research (CBPR), patient and public engagement (PPE)), and those inclusive of a range of KU groups (e.g. children and youth, parents and families, healthcare professionals, decision makers).  

Methods:

This study examined the study and engagement characteristics, strategies, barriers and facilitators, and outcomes and impacts of research partnerships reported in child health research, inclusive of research partnership approaches and KU groups. We identified articles describing child health research conducted in partnership with researchers and KUs in at least one phase of the research process published between 2007 and 2019. Results were summarized using descriptive statistics. An update is currently underway to include studies published to December 2021. 

Results:

In the original search, 16,143 abstracts were identified and seventy-seven articles were included in the review predominating from the United States (59.7%), Canada (19.5%) and the United Kingdom (11.7%). Over half were published between 2015 and 2019 (59.7%) with the most frequently used terminology being CBPR (57.1%), participatory research (10.4%), iKT (5.2%) and PPE (5.2%). Children and/or youth (51.9%), community members (45.5%), and parents or families (32.5%) were the most frequently engaged KU groups; however, most studies engaged with multiple KU groups (63.8%). KUs were most frequently engaged in developing study design and methods (64.9%). Studies often used multiple strategies to engage, predominantly formal meetings (64.9%), providing training opportunities or resource materials (23.4%), informal conversations (18.2%), and establishing working groups (15.6%). Forty-six (59.7%) studies reported beneficial outcomes or impacts of engagement, including increased capacity, knowledge and skills among KUs (27.3%) and researchers (23.4%), the ability to create system changes or action (22.1%), and the generation of high-quality research (29.5%). Twelve studies (15.6%) reported outcomes that were challenging, including personal challenges (9.1%), and challenges with the research process itself (7.8%). Barriers and facilitators of engaging KUs were reported in just over half of included studies (50.7%), with facilitators including use of intermediaries (15.6%), having clearly defined and articulated roles and expectations (10.4%) and maintaining good communication throughout the research process (9.1%). The most-frequently reported barriers were time (11.7%), competing agendas, interests and priorities (10.4%), and lack of resources to support engagement (6.5%).

Conclusion:

This study characterizes research partnerships in child health, which predominantly originated from North America and the UK and used CBPR approaches. Although over half of studies reported outcomes and impacts of research partnerships, there is ongoing need to optimize reporting consistency to facilitate growth in the field, and to conduct additional studies to examine what makes child health a unique context for research partnerships. 

Leah Crockett poster

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A Network’s Approach to Adapting Knowledge Translation Strategies for Neuromuscular Diseases

Submitted by:

Cynthia Gagnon

Email:

cynthia.gagnon4@usherbrooke.ca

Author(s)

Gagnon, Cynthia Osman, Homira Muslemani, Samar Betty, Erin Lochmuller, Hanns

Institution of primary author:

Université de Sherbrooke

Background: 

Rare diseases, such as neuromuscular disease (NMD), present a plethora of challenges and barriers in clinical and research practice. Moving knowledge into action for more effective practice, programs and policy can be challenging using traditional knowledge translation (KT) frameworks and practices: existing KT frameworks were developed with common diseases in-mind and have not addressed the specific considerations surrounding rare diseases for which gold standard evidence is not always available. In addition to generally ‘lower-level’ evidence, there is limited awareness of NMDs and practice guidelines. Knowledge translation products are not well known by clinic teams, allied health professionals, patients and their families and typically apply to scarce knowledge users. Patients with NMDs regularly encounter challenges in healthcare professionals’ expertise and in practice guidelines, and this causes a high level of uncertainty and ambiguity in healthcare processes (e.g., misdiagnoses, delays in specialized care and treatment). It also places an ‘emotional burden’ on patients to serve as knowledge users and knowledge champions, whereby they are tasked with not only sourcing but also sharing information to inform decision-making. Such barriers have highlighted the urgent need for a coordinated effort to develop, disseminate, implement or monitor uptake of KT products. 

Methods: 

Since its inception in early 2020, the Neuromuscular Disease Network for Canada (NMD4C), a pan-Canadian network has brought together the country’s leading clinical, scientific, technical, and patient expertise to improve care, research, and collaboration in neuromuscular disease. NMD4C dedicated a work package to KT in order to address gaps in mobilizing knowledge and improving awareness of NMDs. The NMD4C KT working groups engages patient experts, patient organizations, local champions in NMD clinics (physicians and allied health) and researchers to tailor information for different audiences, provide consultation and training on integrated and end-of-grant KT plans for investigators, adapt and disseminate existing clinical guidelines in the Canadian context, and create clinician- and patient-friendly materials. In the case of one neuromuscular disease, Spinal Muscular Atrophy, where robust changes have been observed in the clinical and research landscape recently, NMD4C has successfully introduced unique KT approaches and tools to positively influence clinical care, outcomes and public policy.

Results: 

NMD4C has meaningfully partnered with patient advocacy groups to influence health policy decisions (i.e., advocacy for newborn screening, influencing access and reimbursement to life-changing therapies with impactful submissions to drug regulators); leveraged social media platforms to disseminate key messages and information and reach a broad audience; convened medical and scientific experts to publish a consensus statement on a newly-approved gene-replacement therapy; developed a clinical practice guideline adaption process; worked towards a decision-aid tool to support clinicians, patients and families to make informed treatment decisions; and held accredited virtual education webinars which has made sharing clinical and research updates easier and has facilitated uptake of knowledge. In this presentation, we aim to share the barriers and facilitators to KT for neuromuscular disease, some of which were amplified during the pandemic, and provide effective KT activities that have improved access and uptake of information that have raised standards of care and research.

Cynthia Gagnon poster
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Navigating Sexual & Reproductive Health: Perspectives of Im/migrant Youth in BC

Submitted by:

Zeba Khan

Email:

zeba.khan@ubc.ca

Author(s)

Zeba Khan, Michelle Fortin, Sarah Munro

Institution of primary author:

The University of British Columbia

Background:

Immigrant populations, particularly youth, experience higher rates of unmet sexual and reproductive health (SRH) need in Canada. In the absence of culturally appropriate and accessible SRH care, they face an increased risk of harm when engaging in normal, healthy sexual behaviours for their age. A three-pronged approach where im/migrant youth are provided with adequate sexual health education, a safe and supportive environment, and access to culturally competent SRH care can meet the current deficits in Canada. This requires a collaborative effort between healthcare providers, community-based service providers, and health promotion and education providers. We conducted two knowledge exchange workshops with community-based organizations that support im/migrant youth with settlement services in promoting SRH in British Columbia. Our objective was to identify knowledge and access gaps to culturally competent SRH care for im/migrant youth, to inform the design of KT interventions to address those gaps.  

Methods:

We conducted two focus group discussions, with 12 participants in a virtual setting. Participants were recruited using a snowball sampling method and represented various community-based organizations in BC. We used graphic facilitation and thematic analysis to interpret discussion and presented results back to participants in the form of an illustrated infographic.

Results:

The focus group discussions facilitated knowledge exchange between the community stakeholders. Results highlighted that community organizations are often the first point of contact and a trusted source for im/migrant youth and their families looking for SRH information. These organizations are well-positioned to provide language support to make SRH care accessible. However, most community organizations providing settlement services lack formal training or programming to promote SRH care. The discussion identified that providing comprehensive resources and training would bolster capacity in staff and allow them to support im/migrant youth in seeking SRH care. Leveraging partnerships with health organizations focussing on SRH care can lead to stronger referral pathways for youth. Participants also shared that community-based organizations could explore introductory workshops or public events to establish themselves as a safe and trusted resource for youth seeking SRH care. Participants will use our co-produced infographic to support awareness-raising within their networks and forge new partnerships.

Conclusions:

Our KT workshops identified that community-based organizations that provide settlement services to im/migrant youth are well-positioned to help youth navigate SRH care. However, due to a lack of formal programming, training, established referral pathways, community-based organizations are underutilized as a source for acquiring information on SRH care. In the next phase of our study, we plan to interview immigrant youth, healthcare providers and co-develop a digital KT intervention with our community stakeholders to enhance access to SRH care.

Zeba Khan

 

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A systematic, consensus-based approach to select theories, models and frameworks for implementation practice: Development using a case example with hip protector use in long-term care and proposal of a model

Submitted by:

Alexandra Korall

Email:

Alexandra.Korall@umanitoba.ca

Author(s)

Alexandra MB Korall, Vicki Komisar, Dawn C Mackey, Femke Hoekstra, Susan Brown, Fabio Feldman, Pauli Gardner, Christine Hames, Masood Khan, Kathryn M Sibley

Institution of primary author:

University of Manitoba

Background:

Use of theories, models and/or frameworks (TMFs) in implementation practice is recommended for developing implementation strategies. However, TMF selection is made difficult by the high number of TMFs to choose from. Our first objective was to systematically choose TMFs to guide an ongoing project to facilitate implementation of hip protectors in long-term care (LTC). Hip protectors, consisting of shields or pads held in pockets covering lateral aspects of the proximal femur, can prevent hip fractures due to falls among older adults living in LTC. Our project goals are to explore determinants of hip protector use and to investigate organizational readiness for change in LTC homes with low use of hip protectors. Our second objective was to propose a model for TMF selection based on the process we developed in our hip protector project.

Methods:

We developed and used a five-step, systematic, consensus-based and integrated knowledge translation (iKT) process, involving: (1) a structured search strategy to identify TMFs; (2) screening of TMFs against pre-established eligibility criteria based on the purpose of TMFs; (3) appraisal of the relevance of TMFs using a structured questionnaire adapted from the Theory Comparison and Selection Tool (T-CaST); (4) identifying the three TMFs most relevant for each project goal; and (5) the final selection based on the top three TMFs through an on-line consensus-meeting using an adapted Nominal Group Technique with knowledge users and final approval by our institutional partners.

Results:

We identified 66 TMFs in step 1, of which 23 met our eligibility criteria in step 2. Five investigators appraised the 23 TMFs in step 3, over two months. The top three TMFs relevant to each project goal identified in step 4 were: Project goal 1=Normalization Process Theory, the Exploration, Preparation, Implementation, Sustainment Model, and the Practical, Robust Implementation and Sustainability Model (PRISM); Project goal 2= Organizational Readiness Theory, the Consolidated Framework for Implementation Research (CFIR), and the Precede-Proceed Model. Nine investigators, one patient partner, and two institutional partners participated in the consensus meeting in step 5. Two combinations, each comprised of two TMFs, tied with the most votes after three rounds of voting. The tie was broken through collaboration with three institutional partners, who selected the PRISM and CFIR. We propose that the process we developed may be referred to as the Implementation Theory Selection (ITS) Model.

Conclusions:

The ITS Model we developed offers a systematic, consensus-based, iKT process to select TMFs, which we used to inform investigations into determinants of hip protector use and organizational readiness for change in LTC. The value of this approach is best illustrated by our selection of the PRISM, whom no investigators or partners were previously aware of. Our approach also provided an opportunity for investigators to engage with knowledge users early in the project’s lifespan, which may facilitate meaningful partnerships in later phases of the project. Although continued research is needed to evaluate and refine our model, it has laid the foundation for a first iteration a process model for identifying and selecting TMFs for implementation practice.

Alexandra KORALL

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A new taxonomy was developed for overlap across ‘Overviews of systematic reviews’: a meta-research study of research waste

Submitted by:

Carole Lunny

Email:

Carole.Lunny@ubc.ca

Author(s)

Carole Lunny, Jia He Zhang, Alyssa Chen, Trish Neelakant, Gavindeep Shinger, Adrienne Stevens, Sara Tasnim, Shadi Sadeghipouya, Stephen Adams, Yi Wen Zheng, Lester Lin, Pei Hsuan Yang, Manpreet Dosanjh, Peter Ngsee, Ursula Ellis, Beverley J. Shea, Emma K. Reid, James M. Wright

Institution of primary author:

Knowledge Translation Program, St Michaels Hospital, Unity Health Toronto

Background:

Multiple ‘overviews of reviews’ conducted on the same topic (“overlapping overviews”) represent a waste of research resources and can confuse clinicians making decisions amongst competing treatments. We aimed to assess the frequency and characteristics of overlapping overviews.

Methods:

MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews were searched for overviews that: synthesised reviews of health interventions and conducted systematic searches. Overlap was defined as: duplication of PICO eligibility criteria, and not reported as an update nor a replication. We categorized overview topics according to 22 WHO ICD-10 medical classifications, overviews as broad or narrow in scope, and overlap as identical, nearly identical, partial, or subsumed. Subsummation was defined as when broad overviews subsumed the populations, interventions and at least one outcome of another overview.

Results:

Of 541 overviews included, 169 (31%) overlapped across similar PICO, fell within 13 WHO ICD-10 medical classifications, and 62 topics. 148/169 (88%) overlapping overviews were broad in scope. Fifteen overviews were classified as having nearly identical overlap (9%); 123 partial overlap (73%), and 31 subsumed (18%) others.

Conclusions:

One third of overviews overlapped in content and a majority covered broad topic areas. A multiplicity of overviews on the same topic adds to the ongoing waste of research resources, time and effort across medical disciplines. Authors of overviews can use this study and the sample of overviews to identify gaps in the evidence for future analysis, and topics that are already studied which do not need to be duplicated.

Carole Lunny poster taxonomy

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Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

Submitted by:

Carole Lunny

Email:

Carole.Lunny@ubc.ca

Author(s)

"Carole Lunny, Cynthia Ramasubbu, Lorri Puil, Savannah Gerrish, Tracy Liu, Douglas M. Salzwedel, Barbara Mintzes, James M. Wright "

Institution of primary author:

St Michael’s Hospital, Unity Health Toronto

Introduction:

Assessing the process used to synthesise the evidence in clinical practice guidelines (CPGs) enables users to determine the trustworthiness of the recommendations. We aimed to assess whether systematic methods were used when synthesizing the evidence for CPGs; and whether reviews or ‘overviews of reviews’ were cited in support of recommendations.

Methods and Analysis:

We followed a study protocol. CPGs published in 2017 and 2018 were retrieved from TRIP and Epistemonikos. We randomly sorted and sequentially screened the CPGs to select the first 50 that met our inclusion criteria. Our primary outcomes were the numbers and proportions of recommendations that were based on reviews and ‘overviews‘, and CPGs using either a systematic or non-systematic process to gather, assess, and synthesise evidence. We also looked for evidence that critical appraisal was conducted. We also performed a chi-square test of independence to examine the relationship between variables.

Results: 

Of the 50 guidelines, 34% did an exceptional job in systematically synthesising the evidence to inform recommendations. These guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. 66% of CPGs reported non-systematic methods to develop their recommendations. This percentage is likely an underestimation because we excluded some CPGs when selecting studies. Overall, 90% of CPGs cited reviews to inform recommendations, and one fifth cited a Cochrane systematic review. Of the 29 CPGs that included reviews, 21% critically appraised the review. 60% of CPGs assessed the quality of primary studies.

Conclusions:

We used novel methodology to evaluate recommendations in a random sample of CPGs, and found that 62% did not use a systematic process to gather, appraise, and synthesise the evidence. Significant improvement is needed in the conduct and reporting of CPG methods. Guideline developers should use systematic methods endorsed by reputable evidence synthesis organisations.

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De-implementation of Low-value Albumin Fluid Resuscitation in Critical Care – Customized KT during a Pandemic

Submitted by:

Daniel Niven

Email:

daniel.niven@ahs.ca

Author(s)

Daniel J. Niven, Karen Shariff, Sampson Law, Kristin Robertson, Andrea Soo, Danny J. Zuege, Sean M. Bagshaw, Selena Au, Jo Harris, Henry T. Stelfox

Institution of primary author:

University of Calgary

Background:

Overuse of low-value care remains a major threat to providing high quality healthcare. Fluid resuscitation using human albumin is an exemplar low-value care practice. Albumin is a blood product used intravenously to treat patients whose intravascular volume is severely reduced. Evidence has identified a small number of patient populations that derive benefit from use of intravenous albumin, however the vast majority of albumin is commonly prescribed for patients where rigorous science indicates no benefit. The objective of the current study was to reduce low-value albumin use among adults admitted to ICUs in Alberta, Canada.

Methods:

The RATIONALE (cRitical cAre opTimIzatiON of ALbumin ordEring in Alberta) study was a registry-based stepped wedge quality improvement intervention trial implemented in all 16 adult ICUs in Alberta. Implementation was facilitated by collaboration with the Alberta Critical Care Strategic Clinical Network as well as the Physician Learning Program. Clusters of two ICUs began using the intervention every two months until all 16 ICUs were using the intervention. The quality improvement intervention targeted established barriers and facilitators and was co-developed by a multi-disciplinary working group and consisted of: 1) identifying clinical champions in each ICU; 2) targeted and tailored education to prescribers and bedside nurses; 3) changes to the way in which albumin was ordered; and 4) bi-monthly unit-level audit and feedback. Data was obtained from eCritical, the provincial electronic medical record and data registry for all ICUs. The primary outcome was the proportion of patients without an evidence-based indication for albumin who received at least one unit of albumin during ICU admission. Secondary outcomes included the number of albumin units prescribed per patient that received any albumin, and the amount of avoided biomedical waste. 

Results:

Intervention implementation began with the first cluster of ICUs in November 2019. The final ICUs were brought onboard January 2021. COVID-19 interrupted implementation by six months between March and August 2020, and delayed audit and feedback by another 6 months in 2021. The proportion of patients without an evidence-based indication for albumin who received at least one unit of albumin during ICU admission decreased from 12.9% at baseline to 9.0% as of October 2021 (relative decrease 30.2%). All but one participating ICU decreased albumin utilization compared to baseline (median relative reduction 24.4%; interquartile range: 4.7% – 39.0%). This resulted in 572 patients avoiding unnecessary exposure to a blood product. The number of albumin prescriptions per patient did not change considerably compared to baseline (4.0 versus 3.9), however owing to a reduction in use of the glass bottles used to store albumin, 1329kg has been prevented from entering biomedical waste. 

Conclusions:

A targeted and tailored, multifaceted quality improvement intervention resulted in considerable reduction in low-value albumin use among patients admitted to adult ICUs in Alberta. Pandemic-related strain significantly hampered timelines associated with planned non-pandemic quality improvement work. Additional work to sustain the observed change in practice is ongoing.