Improvement in neonatal intensive care unit care: A cluster randomised controlled trial of active dissemination of information

Abstract

Background: Research findings are not rapidly or fully implemented into policies and practice in care. Objectives: To assess whether an 'active' strategy was more likely to lead to changes in policy and practice in preterm baby care than traditional information dissemination. Design: Cluster randomised trial. Participants: 180 neonatal units (87 active, 93 control) in England; clinicians from active arm units; babies born <27 weeks gestation. Control arm: Dissemination of research report; slides; information about newborn care position statement. Active arm: As above plus offer to become 'regional 'champion' (attend two workshops, support clinicians to implement research evidence regionally), or attend one workshop, promote implementation of research evidence locally. Main outcome measures: timing of surfactant administration; admission temperature; staffing of resuscitation team present at birth. Results: 48/87 Lead clinicians in the active arm attended one or both workshops. There was no evidence of difference in post-intervention policies between trial arms. Practice outcomes based on babies in the active (169) and control arms (186), in 45 and 49 neonatal units respectively, showed active arm babies were more likely to have been given surfactant on labour ward (RR=1.30; 95% CI 0.99 to1.70); p=0.06); to have a higher temperature on admission to neonatal intensive care unit (mean difference=0.29oC; 95% CI 0.22 to 0.55; p=0.03); and to have had the baby's trunk delivered into a plastic bag (RR=1.27; 95% CI 1.01 to 1.60; p=0.04) than the control group. The effect on having an 'ideal'resuscitation team at birth was in the same direction of benefit for the active arm (RR=1.18; 95% CI 0.97 to 1.43; p=0.09). The costs of the intervention were modest. Conclusions: This is the first trial to evaluate methods for transferring information from neonatal research into local policies and practice in England. An active approach to research dissemination is both feasible and cost-effective. Trial registration: Current controlled trials ISRCTN89683698.