Study procedures — incremental TEACH audit and feedback intervention
In addition to the usual supervisor-led audit and feedback, sites randomized to the TEACH intervention will receive targeted C-SAT/SBT support from the centralized tele-critical care team. This will extend the local leader’s ability to promote increased adherence to C-SAT/SBT through direct messaging, education, and feedback. To support local ICU leaders during the initial education period, the tele-critical care nurse and respiratory therapist team members will develop educational materials and conduct trainings, including how to communicate with tele-critical care when they need assistance (see Table Strategies for deployment of the telehealth-enabled remote audit and feedback (TEACH intervention)Define standard workflow for the TEACH interventionIdentify and address barriers to adherenceInteractions between the tele-critical care clinician and the bedside clinician are documented in the real-time electronic dashboard. Periodic reports on patterns in TEACH interactions and feedback from front-line clinicians are provided to local leaders of tele-supported sites. Local ICU leaders and champions will be coached to use this information to craft messaging, set goals, and make adjustments as needed with local bedside nurses and respiratory therapists.