Improvement in neonatal intensive care unit care: a cluster randomised controlled trial of active dissemination of information
- Dominique Acolet1,2,
- Elizabeth Allen1,
- Rosie Houston2,
- Andrew R Wilkinson3,
- Kate Costeloe4,
- Diana Elbourne1
- 1Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- 2Centre for Maternal and Child Enquiries (CMACE), London, UK
- 3Neonatal Unit, University of Oxford, John Radcliffe Hospital, Oxford, UK
- 4Neonatal Unit, Homerton Hospital, Hackney, London, UK
- Correspondence to Professor Diana Elbourne, Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
Contributors DA and DE had the original idea for the study; Michael Weindling was a co-applicant to Bliss for funding and a member of the Trial Steering Committee with AW (Chair), KC, Jane Abbott, RC, and SG. Richard Condon, Shona Golightly, Jana Kovar and particularly RH provided support at CEMACH; John Lavis (JL) helped with the literature review; Deborah Davidson, Kim Jelphs, and Edward Peck helped to develop and deliver the interventions; the EPICure2 team (especially KC and Elizabeth Draper) supported data collection; Felicity Clemens provided the randomisation; EA supported DA in the statistical analyses and completed the analyses when DA was unable to due to his deteriorating health. DA and DE wrote the first draft of the paper. Except for the late DA, all co-authors (DE, AW, EA, RH and KC) have commented on and agreed the final version. DE is the guarantor.
- Accepted 1 February 2011
- Published Online First 10 March 2011
Background Research findings are not rapidly or fully implemented into policies and practice in care.
Objectives To assess whether an ‘active’ strategy was more likely to lead to changes in policy and practice in preterm baby care than traditional information dissemination.
Design Cluster randomised trial.
Participants 180 neonatal units (87 active, 93 control) in England; clinicians from active arm units; babies born <27 weeks gestation.
Control arm Dissemination of research report; slides; information about newborn care position statement.
Active arm As above plus offer to become ‘regional ‘champion’ (attend two workshops, support clinicians to implement research evidence regionally), or attend one workshop, promote implementation of research evidence locally.
Main outcome measures timing of surfactant administration; admission temperature; staffing of resuscitation team present at birth.
Results 48/87 Lead clinicians in the active arm attended one or both workshops. There was no evidence of difference in post-intervention policies between trial arms. Practice outcomes based on babies in the active (169) and control arms (186), in 45 and 49 neonatal units respectively, showed active arm babies were more likely to have been given surfactant on labour ward (RR=1.30; 95% CI 0.99 to1.70); p=0.06); to have a higher temperature on admission to neonatal intensive care unit (mean difference=0.29oC; 95% CI 0.22 to 0.55; p=0.03); and to have had the baby's trunk delivered into a plastic bag (RR=1.27; 95% CI 1.01 to 1.60; p=0.04) than the control group. The effect on having an ‘ideal’ resuscitation team at birth was in the same direction of benefit for the active arm (RR=1.18; 95% CI 0.97 to 1.43; p=0.09). The costs of the intervention were modest.
Conclusions This is the first trial to evaluate methods for transferring information from neonatal research into local policies and practice in England. An active approach to research dissemination is both feasible and cost-effective.
Trial registration Current controlled trials ISRCTN89683698
DA led this research and wrote the first draft of the paper but died in 2008, before it was completed
Funding The trial was funded by the Bliss Innovation in Care Programme. Further support, including additional data collection, was provided by CEMACH (now CMACE), who acted as the sponsor. Both Bliss and CEMACH were represented on the Steering Committee for the trial and provided comments on study design; the collection and interpretation of data; the writing of the report and in the decision to submit the article for publication.
Competing interests None.
Ethics approval This study was conducted with the approval of the Multi-centre Research Ethics Committee, and the East London and the City Local Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.