Supportive noninvasive ventilation for acute chest syndrome prevention in hospitalized children with sickle cell disease: Determinants of implementation.

BACKGROUND

In 2017 Boston Medical Center's (BMC) general pediatric inpatient unit implemented bi-level positive airway pressure (BiPAP) as supportive noninvasive ventilation for acute chest syndrome prevention (SNAP) to prevent adverse respiratory outcomes among medically stable, hospitalized patients with sickle cell disease. Barriers and facilitators to SNAP implementation at BMC differ from those in other settings.

OBJECTIVE

To examine contextual determinants of SNAP implementation across different settings.

METHODS

We conducted semi-structured interviews with inpatient clinicians at three sites (Site 1: extensive implementation, Site 2: limited implementation, Site 3: not implemented) about factors that would affect SNAP implementation. Interviews and analysis were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.

RESULTS

We interviewed 29 healthcare workers (physicians, nurses, physician assistants, child life specialists, respiratory therapists and psychologists). Five major themes emerged: (1) Communication between staff, particularly between the night and day shift, is critical for BiPAP initiation and success. (2) Nurses are key to successful SNAP implementation. (3) SNAP implementation requires multidisciplinary support, including integration of respiratory therapists and child life. (4) Individual unit level size, culture and workflow influence implementation (5) Hospital resources and leadership support are important for SNAP implementation.

CONCLUSIONS

Successful SNAP implementation across different contexts will require optimized communication between healthcare team members and the integration of respiratory therapy and child life early in the process of BiPAP initiation. Adapting to the unique features of each institution will be critical.