• T Elizabeth Robertson, Henry J Mann, Robert Hyzy, Angela Rogers, Ivor Douglas, Aaron B Waxman, Craig Weinert, Philip Alapat, Kalpalatha K Guntupalli, Timothy G Buchman, and Partnership for Excellence in Critical Care.
• Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA. robertsont@wudosis.wustl.edu
• Crit. Care Med. 2008 Oct 1; 36 (10): 2753-62.

ObjectiveEvidence-based practice recommendations abound, but implementation is often unstructured and poorly audited. We assessed the ability of a peer network to implement an evidence-based best practice protocol and to measure patient outcomes.DesignConsensus definition of spontaneous breathing trial followed by implementation in eight academic medical centers.SettingSix medical, two surgical, and two combined medical/surgical adult intensive care units among eight academic medical centers.Study PopulationPatients initiating mechanical ventilation through an endotracheal tube during a 12-wk interval formed the study population.InterventionsAdoption and implementation of a common spontaneous breathing trial protocol across multiple intensive care units.Measurements And Main ResultsSeven hundred five patients had 3,486 safety screens for conducting a spontaneous breathing trial; 2072 (59%) patients failed the safety screen. Another 379 (11%) patients failed a 2-min tolerance screen and 1,122 (34%) patients had a full 30-120 min spontaneous breathing trial performed. Seventy percent of eligible patients were enrolled. Only 55% of passing spontaneous breathing trials resulted in liberation from mechanical ventilatory support before another spontaneous breathing trial was performed.ConclusionsPeer networks can be effective in promoting and implementing evidence-based best practices. Implementation of a best practice (spontaneous breathing trial) may be necessary for, but by itself insufficient to achieve, consistent and timely liberation from ventilator support.

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