Trial overview and design
As shown in Fig. Clinical trial diagram showing the measurement of baseline implementation and clinical effectiveness outcomes, randomization (R) of the 12 study hospitals to supervisor-led audit and feedback (6 hospitals) or supervisor-led audit and feedback plus the TEACH intervention (6 hospitals). The diagram also shows a future aim at the conclusion of the TEACH clinical trial that will evaluate sustainment in outcomes utilizing fewer resources in both the TEACH intervention and control armsType II effectiveness-implementation trials place equal importance on clinical effectiveness and implementation outcomes, an appropriate design given this study’s purpose to determine the utility of the TEACH implementation intervention as a method for (1) improving adherence to C-SAT/SBT and (2) improving clinical outcomes as measured by ventilator-free days [A future aim will include a sustainment period that will test if lower intensity interventions impact adherence to the implementation outcomes.