“AC3KTION NET” KNOWLEDGE TRANSLATION               NETWORK   TRANSMISSION DES CONNAISSANCES            « AC3KTION NET »   ...
Your Hosts & PresentersVos hôtes et présentateurs             Bruce Harries, Moderator                   Ardis Eliason, Te...
Interacting in WebEx: Today’s Tools     Interagir dans Webex : outils à utiliserHave you used WebEx before?Avez-vous déjà ...
Who’s Online?                 Qui est en ligne?POINTER    02/12/2013                                 4
POINTER          What professions are represented?                 Quelles professions sont représentées?  Nurse          ...
Objectives  But de l’appel                                          1. Revoir la nécessité d’accroître 1. To review the ...
“aC3KTion Net”Dr. John Muscedere
a Canadian Critical CareKnowledge Translation Network     “aC 3KTion   Net”
Learning Objectives• To understand the need for knowledge  translation (KT) in Critical Care• To review the need for measu...
Need for Knowledge          Translation in Critical Care• Lag between generation of research evidence and its  implementat...
What is Knowledge Translation?CIHR defines knowledge translation (KT) as:   “a dynamic and iterative process that includes...
Why is there a need for KT efforts?• Average of 17 years for new knowledge to have impact on  bedside standards of practic...
Why is there a need for KT efforts?• A large gulf remains between what we know and what we  practice.• Variation in implem...
Variation in Quality Scores for                 Pneumonia at Academic Medical                          Centers (2004)     ...
Why Focus KT efforts on              Critical Care?• Patient Vulnerability:   – ICU patients experience high morbidity and...
Why Focus KT efforts on       Critical Care?• Access:   – 80% to 100% increase in the number of     critically ill patient...
Best practices not uniformly              applied in critical care• Wide variations documented in  application of commonly...
Uneven adoption of best     practices- VAP prevention Recent Survey (518 U.S. Hospitals)   21% used ETTs with SSD   40%...
Variance in the Application of       Best Practices• Reasons include:  1. Lack of research evidence      • Can inform futu...
Expanding Critical Care Literature Base: Number of      critical care RCTs published per year  600                        ...
Challenge in delivery of Critical         Care from a KT perspective• Team based care   – Need to reach RNs, RTs, Pharmaci...
Bridging the GapEvidence-BasedBest Practices                                  Clinical Practice                     02/12/...
HOW? KNOWLEDGE-TO-ACTION CYCLETwo phases:1. knowledge creation;2. action cycle                                      Graham...
aC3KTion Net• Network of ICUs (Networks) from across  Canada     • Academic     • Community• Primary activity will be Know...
a Canadian Critical Care Knowledge Translation Network                   aC3KTion Net                        02/12/2013   ...
aC3KTion Net VisionTo improve the care of critically ill throughthe application of best practices as definedby research ev...
aC3KTion Net Scope• All critical care units in Canada will be eligible and  encouraged to participate.• Best practices tha...
aC3KTion Net Objectives1. To bring together critical care researchers and   knowledge users (health care professionals, na...
aC3KTion Net Objectives                Cont’d4. To improve the care of critically ill patients through   the dissemination...
aC3KTion Net Partners/Decision MakersBC              Alberta• Ministry of   • NoelHealth CC       Gibney,                 ...
Network Activities• Knowledge Sources: Canadian Critical Care Trials  Group (CCCTG), Literature, Other• Knowledge Synthesi...
Incubator Units• Testing and modification of knowledge  products in a real world environment  – Involvement of all members...
Measurement- Why? Even when motivated to change our behavior, we  cannot manage what we do not measure. Measurement can ...
Data Collection• Modified point prevalence surveys  – Periodic data collection on cohorts of ICU patients     • 30 pts for...
CCCKTN Activity                     Specific                  Specific                Specific                    Initiati...
KT Initiatives- how to                       choose?• Short term: Knowledge Products Ready for  Implementation after first...
Selection process for                 initiatives• Delphi technique  – Input from Steering/Scientific Committee  – Researc...
Top 5 CURRENT KT             Initiatives1. Pain/Analgesia/Delirium Guidelines2. Sepsis guidelines: new surviving sepsis   ...
Top 10 Future KT              Initiatives1.    End of Life2.    Sedation/Analgesia3.    Sepsis (diagnosis/management)4.   ...
Recruitment of ICUs• Main benefits of participation   –   Access to KT activities   –   Access to KS products   –   Access...
Recruitment of ICUs• ICUs to be recruited through:     • Provincial networks, provincial registries of ICUs     • Advertis...
Timelines/Future Activities• aC3TION Net website   – Go Live, Feb 12, 2013• Recruitment of participating ICUs   – Feb 12, ...
Questions/Comments?       02/12/2013     43
QUESTIONS?RAISE YOUR HAND / LEVEZ LA MAIN            OR/OU   CHAT TO “ALL PARTICIPANTS”
Canadian ICU Collaborative           FacultyChaim Bell; MD, PhD, Associate Professor of Medicine and Health Policy, Manage...
Reminders Rappels Call is recorded             Lappel est enregistré Slides and links to          Les diapositives et ...
National Call Appel national "Learnings from the     « Apprendre de la  Delirium                 Collaboration sur le  C...
THANK YOU  MERCI
This National Call is hosted by:                     Supported by:02/12/2013                           51
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Webinar - Knowledge Translation Network

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Objectives:

1.To review the need for increased efforts to implement research evidence into bedside practice.

2.To review the need for measurement to identify gaps between best practice and actual practice.

3.To demonstrate why there is a need for increased knowledge translation efforts in critical care and how aCKTION Net proposes to fill this need.

Click the link to view the video http://bit.ly/YpJWTC

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Webinar - Knowledge Translation Network

  1. 1. “AC3KTION NET” KNOWLEDGE TRANSLATION NETWORK TRANSMISSION DES CONNAISSANCES « AC3KTION NET » Tuesday, February 12, 2013 Mardi 12 février 2013
  2. 2. Your Hosts & PresentersVos hôtes et présentateurs Bruce Harries, Moderator Ardis Eliason, Technical Host John Muscedere, MD, FRCPC Paule Bernier, DtP., M.Sc.02/12/2013 2
  3. 3. Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliserHave you used WebEx before?Avez-vous déjà utilisé WebEx?  YES / OUI NO / NON  Soyez prêts àBe prepared to use: utiliser les outils : - Pointer - le pointeur - Raise hand - lever la main - CHAT - clavardage - Text Tool - Outil textuel Type your“writing on the slide” pour « écrire sur la message Select - Shape Tools diapo » ‘send to’ & click 02/12/2013 - Outils de forme 3 ‘send’
  4. 4. Who’s Online? Qui est en ligne?POINTER 02/12/2013 4
  5. 5. POINTER What professions are represented? Quelles professions sont représentées? Nurse MD Infection ControlEducator / Quality Administrator /Improvement Senior LeaderProfessional Nutritionist Other Respiratory Therapist 02/12/2013 5
  6. 6. Objectives But de l’appel  1. Revoir la nécessité d’accroître 1. To review the need for les efforts pour intégrer les increased efforts to implement données probantes émanant de la recherche dans la pratique au research evidence into bedside chevet des patients. practice.  2. Revoir la nécessité d’instaurer 2. To review the need for des mesures pour identifier les measurement to identify gaps lacunes entre les pratiques between best practice and actual exemplaires et les pratiques practice. réelles. 3. To demonstrate why there is a  3. Démontrer le besoin d’accroître need for increased knowledge les efforts en matière d’application translation efforts in critical care des connaissances dans le domaine des soins critiques et la and how aCKTION Net proposes façon dont aCKTION Net propose to fill this need. de combler ce besoin. 02/12/2013 6
  7. 7. “aC3KTion Net”Dr. John Muscedere
  8. 8. a Canadian Critical CareKnowledge Translation Network “aC 3KTion Net”
  9. 9. Learning Objectives• To understand the need for knowledge translation (KT) in Critical Care• To review the need for measurement as a means to improve practice• To demonstrate how the Canadian Critical Care Knowledge Translation Network (aC3KTion Net) can address the KT needs identified for critical care. 02/12/2013 9
  10. 10. Need for Knowledge Translation in Critical Care• Lag between generation of research evidence and its implementation into best practice• Unknown penetration of new evidence into practice• Few large scale KT initiatives thus far – Patient safety• Minimal resources to conduct KS activities• Increasing focus on Quality – Deriving best outcomes and best value from resources expended. 02/12/2013 10
  11. 11. What is Knowledge Translation?CIHR defines knowledge translation (KT) as: “a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the healthcare system” Canadian Institutes of Health Research. www.cihr-irsc.gc.ca/e/39033.html. 02/12/2013 11
  12. 12. Why is there a need for KT efforts?• Average of 17 years for new knowledge to have impact on bedside standards of practice• Reasons include: – Slow diffusion of research evidence into practice – Limited comparative effectiveness research to guide implementation, investments and use of technologies – Lack of health system policies across jurisdictions – Research groups and clinical communities working in isolation – Literature base is rapidly expanding such that it is difficult for individual practitioners to remain current, assimilate and then apply evidence into practice. IOM. Crossing the quality chasm: A new health system for the 21st century. 2001. 02/12/2013 12
  13. 13. Why is there a need for KT efforts?• A large gulf remains between what we know and what we practice.• Variation in implementation is common internationally, within countries, between regions and even between hospitals.• Even where guidelines exist, large gaps continue to exist between best evidence and practice.• Example- CV Medicine: – 30% to 40% of patients fail to receive treatments of proven effectiveness – 20% to 25% of patients may receive care that is not needed or is potentially harmful Davis et al. BMJ 2003; 327: 33-35. Tremblay et al, Can J Cardiol 2004; 20:1195-98. 02/12/2013 13
  14. 14. Variation in Quality Scores for Pneumonia at Academic Medical Centers (2004) 95.0 85.0Percentage (%) Percentage of 3 care measures received: 75.0 1. Timely administration of antibiotics 2. Measurement of SaO2 3. Immunization 65.0 55.0 45.0 John Wennberg, The Eisenberg Legacy Lecture Stanford, California. Nov. 2, 2005. 02/12/2013 14
  15. 15. Why Focus KT efforts on Critical Care?• Patient Vulnerability: – ICU patients experience high morbidity and mortality – Ontario • Level 3 pts- 20% mortality • Level 2 pts- 10% mortality• Patient Volume: – ICU patients per year: - Canada- 360,000 pts. Globe and Mail, Nov. 24, 2011 02/12/2013 15
  16. 16. Why Focus KT efforts on Critical Care?• Access: – 80% to 100% increase in the number of critically ill patients over the next 20 years – Demand will overwhelm capacity in the next 10 years• Health Care Costs: – In Canada (2004): ICU costs were estimated to account for 15.9% of the $39 billion spent on hospital services – 0.5 – 1.0 % of GDP 02/12/2013 16
  17. 17. Best practices not uniformly applied in critical care• Wide variations documented in application of commonly applied therapies for critically ill patients • Sepsis • ARDS • Sedation practices • Transfusion practices • Non-invasive ventilation • Renal replacement therapy • End of Life Care • Etc. 02/12/2013 Hirshberg et al, Chest 2008; 133: 1335. 17
  18. 18. Uneven adoption of best practices- VAP prevention Recent Survey (518 U.S. Hospitals)  21% used ETTs with SSD  40% use antimicrobial mouth rinses  82% utilized semi-recumbent positioning 02/12/2013 Krein. Infect Control Hosp Epi.18 2008
  19. 19. Variance in the Application of Best Practices• Reasons include: 1. Lack of research evidence • Can inform future research directions 2. Lack of awareness or lack of dispersion of best practices • Can be improved by knowledge synthesis or knowledge translation activities 02/12/2013 19
  20. 20. Expanding Critical Care Literature Base: Number of critical care RCTs published per year 600 560 550 500 2010 Modified from Kahn, CCM 2009; 37: S147
  21. 21. Challenge in delivery of Critical Care from a KT perspective• Team based care – Need to reach RNs, RTs, Pharmacists, Dieticians, PTs etc.• Physician challenges: – Large amounts of critical care delivered by non-intensivists – Critical care may only be a small proportion of their practice – Differing backgrounds for MD entry into critical care – Episodic care by physicians• Institutional challenges – Variability in available resources. 02/12/2013 21
  22. 22. Bridging the GapEvidence-BasedBest Practices Clinical Practice 02/12/2013 22
  23. 23. HOW? KNOWLEDGE-TO-ACTION CYCLETwo phases:1. knowledge creation;2. action cycle Graham et al. 2006 02/12/2013 Graham et al. 2006
  24. 24. aC3KTion Net• Network of ICUs (Networks) from across Canada • Academic • Community• Primary activity will be Knowledge Translation and development of Critical Care Knowledge Synthesis products • Not KT Research• Measurement of uptake/outcomes 02/12/2013 24
  25. 25. a Canadian Critical Care Knowledge Translation Network aC3KTion Net 02/12/2013 25
  26. 26. aC3KTion Net VisionTo improve the care of critically ill throughthe application of best practices as definedby research evidence in a timely mannerthereby reducing the morbidity, mortalityand impact of critically patients on thehealth care system. 02/12/2013 26
  27. 27. aC3KTion Net Scope• All critical care units in Canada will be eligible and encouraged to participate.• Best practices that will be included in network activities will be those pertaining to: – clinical practice – ICU organization – administration and organization of critical care resources.• We will include multi-professional representation to encompass the multi-disciplinary nature of ICU teams. 02/12/2013 27
  28. 28. aC3KTion Net Objectives1. To bring together critical care researchers and knowledge users (health care professionals, national professional associations, and health care system decision makers) to optimize resources and support collaborative knowledge translation activities.2. To survey practice at baseline and after implementation efforts to guide knowledge translation activities and measure the results of our efforts.3. To conduct knowledge synthesis activities and develop knowledge products to inform critical care best practices. 02/12/2013 28
  29. 29. aC3KTion Net Objectives Cont’d4. To improve the care of critically ill patients through the dissemination of best practices, as defined by research evidence, into ICUs across Canada.5. To improve critical care outcomes including morbidity, mortality and the health care system impact of critically ill patients. 02/12/2013 29
  30. 30. aC3KTion Net Partners/Decision MakersBC Alberta• Ministry of • NoelHealth CC Gibney, ManitobaWorking Alberta CC Sask. • B.Group clinical Paunovic, Quebec• Fraser Network • Susan Winnipeg Maritimes Shaw, Ontario • M. Légaré,Health CC Head CC U of • W. Patrick, Chair, SIQ Manitoba • B. CC Sask. Dalhousie U. Lawless, quality CC Council Secretariat 1. Canadian Critical Care Society 2. Canadian Association of Critical Care Nurses 3. Canadian Society of Respiratory Therapists 4. Canadian Patient Safety Institute 5. Canadian ICU Collaborative
  31. 31. Network Activities• Knowledge Sources: Canadian Critical Care Trials Group (CCCTG), Literature, Other• Knowledge Synthesis: Development of clinical practice guidelines, evidence syntheses and scoping reviews.• Testing of Knowledge Products: Reviewed and tested before implementation, to ensure acceptability, ability to achieve intended purpose and ascertain possible barriers• Knowledge Implementation: Local teams will use strategies/tools tailored to knowledge product. – Education, protocols, checklists, order sets, organizational changes and reminder systems – PDSA cycles to track implementation activities 02/12/2013 31
  32. 32. Incubator Units• Testing and modification of knowledge products in a real world environment – Involvement of all members of health care team – Knowledge products reviewed for: • Acceptability • Possible barriers to implementation • Possible tools for implementation • Implementation tools designed – Academic hospitals, Community hospitals 02/12/2013 32
  33. 33. Measurement- Why? Even when motivated to change our behavior, we cannot manage what we do not measure. Measurement can identify gaps in best practice. Measurement can illuminate the results of our efforts at implementing best practice. Measurement can inform future research direction. 02/12/2013 33
  34. 34. Data Collection• Modified point prevalence surveys – Periodic data collection on cohorts of ICU patients • 30 pts for large ICUs (> 15 beds) • 20 pts for small ICUs (< 15 beds)• eCRF with MDS that is scalable and modular for new network initiatives as they are developed• Reports of performance for each ICU from data collected 02/12/2013 34
  35. 35. CCCKTN Activity Specific Specific Specific Initiatives Initiatives InitiativesCore Core Core Core CoreData Data Data Data Data Set Set Set Set Set KS/ KT Activity KS/ KT Activity KS/ KT Activity KS/ KT Activity Data Elements 1. Core Data Set Specific 2. Practice Data – specific practices Specific Initiatives Initiatives KS/ KT Activity Core Core Data KS/ KT Activity Data Set Set 02/12/2013
  36. 36. KT Initiatives- how to choose?• Short term: Knowledge Products Ready for Implementation after first data collection period • E.g. guidelines • VAP CPGs, Hypothermia Guidelines, Sepsis guidelines etc.• Longer term: Initiatives based on demonstration of practice variation • To be based on data collected during baseline data collection • Will inform future KT activities/future Research activities • What data to collect? 02/12/2013 36
  37. 37. Selection process for initiatives• Delphi technique – Input from Steering/Scientific Committee – Researchers, clinicians, knowledge users, decision makers Composition of Steering/Committee Scientific Committee 31 Members Total (Overlap) •21 MDs •4 RNs •1 Pharmacist •1 RT •9 Knowledge Users •5 National organization members (CCCS, CACCN, CSRT, CPSI, CICU) 02/12/2013 37
  38. 38. Top 5 CURRENT KT Initiatives1. Pain/Analgesia/Delirium Guidelines2. Sepsis guidelines: new surviving sepsis guidelines3. Canadian Nutrition Guidelines in the Critically Ill4. Implementation of revised Ventilator Associated Pneumonia Guidelines5. Non-Invasive Ventilation Guidelines 02/12/2013 38
  39. 39. Top 10 Future KT Initiatives1. End of Life2. Sedation/Analgesia3. Sepsis (diagnosis/management)4. Early Mobilization5. Delirium (screening/treatment)6. Communication in the ICU7. Anti-Microbial Stewardship8. Quality Improvement Initiatives9. Fluid Therapy (resuscitation, maintenance)10. Utilization of non-invasive mechanical ventilation 02/12/2013 39
  40. 40. Recruitment of ICUs• Main benefits of participation – Access to KT activities – Access to KS products – Access to educational events/webinars – Opportunity to participate in incubator units – Ability to influence network activities – Benchmarked reports of performance with national peers – A vehicle to drive critical care quality improvement• ICUs provide periodic data in return 02/12/2013 40
  41. 41. Recruitment of ICUs• ICUs to be recruited through: • Provincial networks, provincial registries of ICUs • Advertisement through professional societies: CCCS, CSRT, CACCN • Partnerships with existing networks• Any other recruitment strategies?• Any other ways to incentivize ICUs to participate in the network? 02/12/2013 41
  42. 42. Timelines/Future Activities• aC3TION Net website – Go Live, Feb 12, 2013• Recruitment of participating ICUs – Feb 12, 2013 on ward• Outreach to provincial partners, stakeholders – Spring, Summer 2013• Café Scientifique (Town Hall meeting) – Pilot in Kingston, ??? Other cities• Projected start of first data collection period – September 3, 2013 02/12/2013 42
  43. 43. Questions/Comments? 02/12/2013 43
  44. 44. QUESTIONS?RAISE YOUR HAND / LEVEZ LA MAIN OR/OU CHAT TO “ALL PARTICIPANTS”
  45. 45. Canadian ICU Collaborative FacultyChaim Bell; MD, PhD, Associate Professor of Medicine and Health Policy, Management, & Evaluation CIHR/CPSI Chair in Patient Safety & Continuity of Care; University of Toronto; St. Michaels HospitalPaule Bernier, P.Dt., Msc, Sir MB David Jewish General Hospital (McGill University), MontrealPaul Boiteau MD, Department Head, Critical Care Medicine, Alberta Health Services; Professor of Medicine, University of CalgaryMike Cass, BSc, RN, MScN, Advanced Practice Nurse, Trillium Health CentreLeanne Couves, Improvement Advisor, Improvement Associates Ltd.Vanda DesRoches; RN BN, Prince County Hospital, PEIGreg Duchscherer, RRT, FCSRT, Quality Improvement & Patient Safety Leader, Department of Critical Care Medicine, AHS (Calgary Zone)Bruce Harries, Collaborative Director, Improvement Associates Ltd.Gordon Krahn, BSc, RRT, Quality and Research Coordinator, BC Children’s HospitalDenny Laporta MD, Intensivist, Department of Adult Critical Care, Jewish General Hospital; Faculty of Medicine, McGill UniversityClaudio Martin MD,Intensivist, London Health Sciences Centre, Critical Care Trauma Centre; Professor of Medicine and Physiology, University of Western Ontario; Chair/Chief of Critical Care WesternCathy Mawdsley, RN, MScN, CNCC; Clinical Nurse Specialist – Critical Care, London Health Sciences Centre;Sherissa Microys MD, Assistant Professor, University of Ottawa; Intensivist, Ottawa Hospital; Major, Canadian ForcesJohn Muscedere MD, Assistant Professor of Medicine, Queens University; Intensivist, Kingston General HospitalYoanna Skrobik MD, Intensivist, Hôpital Maisonneuve Rosemont, Montréal; Expert Panel for the new Pain, Sedation and Delirium Guidelines, Society of Critical Care Medline (SCCM) 02/12/2013 47
  46. 46. Reminders Rappels Call is recorded  Lappel est enregistré Slides and links to  Les diapositives et liens recordings will be vers les enregistrements available on Safer seront disponibles sur Des soins de santé plus Healthcare Now! sécuritaires maintenant! Communities of Practice Communautés de pratique Additional resources are  Des ressources available on the SHN supplémentaires sont Website and disponibles sur le site Web Communities of Practice SSPSM et Communautés de Pratique 02/12/2013 48
  47. 47. National Call Appel national "Learnings from the  « Apprendre de la Delirium Collaboration sur le Collaborative" delirium » Monday, February 25,  Lundi Février 25 2013 2013  Conférencier invité: Guest Speaker: Yoanna Skrobik, MD, Yoanna Skrobik, MD, FRCPC, Intensiviste, FRCPC, Intensivist, Hôpital Maisonneuve- Hôpital Maisonneuve- Rosemont, Montréal Rosemont, Montréal 02/12/2013 49
  48. 48. THANK YOU MERCI
  49. 49. This National Call is hosted by: Supported by:02/12/2013 51

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