NHLBI convened a workshop to discuss opportunities and needs for implementation science research in critical care. Critical illness is an important public health problem. There are more than 5 million intensive care unit admissions each year in the United States. Morbidity, mortality, and costs associated with critical illness are extremely high, with mortality for critical illness syndromes such as acute respiratory distress syndrome and severe sepsis of up to 50%. NHLBI has a strong interest in critical care research for heart, lung, and blood diseases and a long history of supporting basic and clinical critical care research including efficacy studies.
Data show that evidence-based practices in critical care known to improve patient outcomes often are not implemented in clinical practice. Implementation science is a growing field that can enhance the translation of evidence into practice. The goal of this workshop was to examine gaps and opportunities for implementation science research in critical care.
The workshop included presentations of completed and ongoing implementation research in critical care, presentations on methods and study designs for implementation science research, and discussion of the research gaps and priorities for critical care implementation science. Workshop attendees included experts in critical care, implementation science, and nursing as well as representatives from NIH and other HHS agencies.
- Shannon Carson, MD – University of North Carolina
- Catherine (Terri) Hough, MD, MSc – University of Washington
- Brian Mittman, PhD – Kaiser Permanente
- Gregory Aarons, PhD – University of California, San Diego
- Michelle Balas, PhD, RN – Ohio State University
- Sean Berenholtz, MD, MHS – Johns Hopkins University
- Denna Kelly Costa, PhD, RN – University of Michigan
- Martha A.Q. Curley, PhD, RN – University of Pennsylvania
- Allan Doctor, MD – Washington University in St. Louis
- E. Wesley Ely, MD, MPH – Vanderbilt University
- Michelle Gong, MD – Montefiore Medical Center
- Jeremy Kahn, MD, MS – University of Pittsburgh
- Peter Lindnauer, MD, MSc – Baystate Medical Center
- Jill Marsteller, PhD – Johns Hopkins University
- Mark Mikkelsen, MD, MSCE – University of Pennsylvania
- Gordon Rubenfeld, MD, MSc – University of Toronto
- Kristina Rudd, MD – University of Washington
- Lisa Saldana, PhD – Oregon Social Learning Center
- Anne Sales, PhD, RN – University of Michigan
- Damon Scales, MD, PhD – University of Toronto
- Sharon Straus, MD, MSc – University of Toronto
- Curtis Weiss, MD – Northwestern University
NIH and Other Federal Agency Staff
- Jessica Bellinger, PhD – CSR
- Carol Blaisdell, MD – DLD, NHLBI
- Jeremy Brown, MD – NIGMS
- Jerry Eu, MD – DLD, NHLBI
- Nara Gavini, PhD – CTRIS, NHLBI
- Peyvand Ghofrani, MS – DLD, NHLBI
- Andrea Harabin, PhD – DLD, NHLBI
- Martha Hare, PhD, RN – CSR
- James Kiley, PhD – DLD, NHLBI
- William Lawrence, MD, MS – PCORI
- Nancy Macgarvey, MD – DLD, NHLBI
- George Mensah, MD – CTRIS, NHLBI
- Melissa Miller, BSN, MD, MS – AHRQ
- Antonello Punturieri, MD, PhD – DLD, NHLBI
- Lora Reineck, MD, MS – DLD, NHLBI
- Sung Sug Yoon, PhD, RN – CSR
- Robert Tamburro, MD – NICHD
- Xenia Tigno, PhD – DLD, NHLBI
- Lisa Viviano, BSN – DLD, NHLBI
- Gail Weinmann, MD – DLD, NHLBI
- Implementation science research, as well as de-implementation research, is needed in critical care.
- Knowledge on current levels of evidence-based practice in critical care across clinical settings is needed to identify key implementation gaps.
- Implementation studies should focus on evidence-based practices with an identified implementation gap.
- The evidence base can and should arise from a variety of sources including, but not limited to, clinical trials (efficacy and effectiveness studies) and clinical practice guidelines.
- Interventions should be developed using implementation frameworks selected to target specific settings and needs.
- Observational studies to understand the variability of practice, barriers and facilitators of practice change, and adoption/de-adoption of practices in critical care should be supported.
- Implementation science research should focus on the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice.
- Influences on the healthcare provider and organizational behavior are particularly relevant in the intensive care unit.
- Implementation studies in critical care should take into account the team-based approach to critical care.
- Interventions should be appropriate to the interprofessional nature of critical care.
- Existing implementation science frameworks, models, and metrics may need to be modified or contextualized for the critical care environment.
- Collaborative partnerships between established experts in implementation science and critical care clinical trialists or health services researchers should be encouraged to promote high quality implementation science research in critical care.
- Implementation research may be combined with efficacy/effectiveness trials in order to understand both the efficacy/effectiveness of an intervention and how or why it did/did not work.
- Pilot studies may be needed to confirm the feasibility of proposed implementation interventions.
- Implementation science research in critical care should leverage electronic health records and technology.
- Implementation science is an important training pathway for young investigators in critical care.