Acceptability of the Venting Wisely Pathway for use in Critically ill Adults with Hypoxemic Respiratory Failure and Acute Respiratory Distress Syndrome (ARDS): A qualitative study protocol

IntroductionHypoxemic respiratory failure (HRF) affects nearly 15% of critically ill adults admitted to an intensive care unit (ICU). An evidence based, stakeholder informed multidisciplinary care pathway (Venting Wisely) was created to standardize the diagnosis and management of patients with HRF and Acute Respiratory Distress Syndrome (ARDS). Successful adherence to the pathway requires a coordinated team-based approach by the clinician team. The overall aim of this study is to describe the acceptability of the Venting Wisely pathway among critical care clinicians. Specifically, this will allow us to: 1) better understand the users experience with the intervention and 2) determine if the intervention was delivered as intended. Methods and analysisThis qualitative study will conduct focus groups with nurse practitioners, physicians, registered nurses, and registered respiratory therapists from 17 Alberta ICUs. We will use template analysis to describe the acceptability of a multi component care pathway according to seven constructs of acceptability: 1) Affective attitude; 2) Burden; 3) Ethicality; 4) Intervention coherence; 5) Opportunity costs; 6) Perceived effectiveness; and 7) Self-efficacy. This study will contribute to a better understanding of the acceptability of the Venting Wisely pathway. Identification of areas of poor acceptability will be used to refine the pathway and implementation strategies as ways to improve adherence to the pathway and promote its sustainability. Ethics and disseminationThe study was approved by the University of Calgary Conjoint Health Research Ethics Board (CHREB). The results will be submitted for publication in a peer-reviewed journal and presented at a scientific conference. STRENGTHS AND LIMITATIONSO_LIThis qualitative study will provide vital information about why the implementation of the Venting Wisely pathway may or may not have worked as anticipated. C_LIO_LIFindings will identify opportunities to improve pathway adherence and provide insights on how to sustain the intervention and scale to other sites. C_LIO_LIAcceptance and adherence of the Venting Wisely pathway has the potential to increase and standardize the use of evidence-informed, life-saving therapies for mechanically ventilated patients; this may improve outcomes and save costs to the healthcare system. C_LIO_LIFocus groups will be conducted with a wide variety of clinicians (nurse practitioners, physicians, registered nurses, registered respiratory therapists), and within various intensive care units (general systems, cardiovascular surgery, and neurosciences), and hospitals (regional, community, and tertiary). C_LIO_LIThe study is being conducted in one province in Canada, which may limit generalizability. C_LI