Healthcare / audit partner. Dutch National Intensive Care Evaluation (NICE) quality registry.

Research partners. Academic Medical Center, University of Amsterdam, NL. Health e-Research Centre, University of Manchester, UK.

Context. During their patients’ stay at an intensive care units (ICU) they are exposed to adverse experiences; acute pain being a leading stressor. Physical and psychological stress caused by pain have been shown to be associated with increased length of stay, morbidity and poor mental health outcomes, and affect quality of life even after ICU discharge. There remains a large gap between ideal and actual care with respect to pain management in intensive care.

Aim of audit. To improve clinical performance on recently developed quality indicators relating to pain management in Dutch ICUs.

Scope and scale of audit. All (n=83) Dutch intensive care units.

Aim of research. To investigate ICU professionals’ perceptions about their clinical performance and the influence of A&F on their intentions to change practice; and to assess the effects of an electronic A&F intervention with action implementation toolbox compared to the intervention without toolbox.

A&F interventions being tested. An online quality dashboard that allows users to gain insight into clinical performance and develop action plans. The intervention group additionally receives access to an integrated action implementation toolbox of suggested actions and materials to further support the development and management of action plans.

Evaluation design. First is a laboratory experiment with 72 individual professionals from 21 ICUs to assess the impact of feedback on their intentions to improve practice. Second is a two-arm cluster randomised controlled trial with the same 21 ICUs allocated to feedback without or feedback with action implementation toolbox group. Both arms receive telephone support to increase engagement. In the near future the dashboard is extended with other clinical domains: antibiotics use, mechanical ventilation and blood transfusions.

Oversight. Board of directors at the NICE foundation.

Ethical approval. The Institutional Review Board (IRB) of the Academic Medical Center (Amsterdam, The Netherlands) stated that formal IRB approval and patient consent was not deemed necessary because to the focus of intervention on improving organisational processes; individual patients will not be directly involved (IRB reference number: W16_271)

Audit funding. NICE foundation

Research funding. NICE foundation and Dutch association of Medical Specialists

Trial registration. ClinicalTrials.gov with reference NCT02922101.