Trial strengths
EAGLE has proved a highly effective study design to deliver a complex quality improvement intervention in a wide range of settings across multiple study batches. Translation of resources and batching of clusters has enabled the study to navigate geographic, language and varied pandemic landscapes. The streamlined outcomes and design with incomplete cross sections offered high data completeness with low investigator burden. The trial was powered to efficiently detect reduction of a significant, measurable outcome. Finally, regardless of whether the primary outcome is achieved, the trial delivered a framework for education and operating team communication to hospital teams in all study sequences.