Data from: Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses

Objectives: Low tidal volume (TVe) ventilation improves outcomes for
ventilated patients, and the majority of clinicians state they implement
it. Unfortunately, most patients never receive low TVes. ‘Nudges’
influence decision-making with subtle cognitive mechanisms and are
effective in many contexts. There have been few studies examining their
impact on clinical decision-making. We investigated the impact of 2
interventions designed using principles from behavioural science on the
deployment of low TVe ventilation in the intensive care unit (ICU).
Setting: University Hospitals Bristol, a tertiary, mixed medical and
surgical ICU with 20 beds, admitting over 1300 patients per year.
Participants: Data were collected from 2144 consecutive patients receiving
controlled mechanical ventilation for more than 1 hour between October
2010 and September 2014. Patients on controlled mechanical ventilation for
more than 20 hours were included in the final analysis. Interventions: (1)
Default ventilator settings were adjusted to comply with low TVe targets
from the initiation of ventilation unless actively changed by a clinician.
(2) A large dashboard was deployed displaying TVes in the format mL/kg
ideal body weight (IBW) with alerts when TVes were excessive. Primary
outcome measure: TVe in mL/kg IBW. Findings: TVe was significantly lower
in the defaults group. In the dashboard intervention, TVe fell more
quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached
when compared with controls. This effect improved in each subsequent year
for 3 years. Conclusions: This study has demonstrated that adjustment of
default ventilator settings and a dashboard with alerts for excessive TVe
can significantly influence clinical decision-making. This offers a
promising strategy to improve compliance with low TVe ventilation, and
suggests that using insights from behavioural science has potential to
improve the translation of evidence into practice.