An interventional study of adapted DRAUP strategy bundle in Implementation Science and Behavior and Behavior Mechanisms, sponsored by Washington University School of Medicine. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-04-21.
Sponsored by Washington University School of Medicine · Not applicable, Interventional, and Other
This study proposes adapting and testing an innovative, behavioral theory-driven deimplementation program called DRAUP in two intensive care units for proof of concept and support that the program can help providers and hospital organizations address context determinants of deimplementation. Study data will be used to optimize the intervention for a subsequent larger trials.
There are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. Previously, we developed and initiated a successful evidence-based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We now move to adapt the deimplementation bundle in the new environment of the Intensive Care Unit (ICU) with hopeful continued success.
In experiment 1, qualitative analysis will be employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit and implementation outcomes as well as cost will be evaluated. In experiment 3, mixed methods will be used to evaluate the mechanism of impact of the refined program in the new environment.
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This study's enrollment of 101 is below the median of 120 across 295 interventional studies indexed under Behavior.
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-Measure the effectiveness and cost effectiveness of DRAUP on discontinuation of CXRs
Inclusion Criteria for DRAUP training:
(1) ICU faculty, fellows, senior residents (post graduate year 3) and advanced practice practitioners
new mode of CVC confirmation for correct location and excluding pneumothorax
Behavioral: adapted DRAUP strategy bundle
traditional mode of CVC confirmation for correct location and excluding pneumothorax
Behavioral: adapted DRAUP strategy bundle
DRAUP deimplementation strategy bundle includes: 1) education and training, 2) supervision and in-person decision support, and 3) audit and feedback to target capability. Opportunity is addressed by 4) algorithm development and 5) organizational support. Finally, 6) facilitators and 7) planned adaptation after interval program assessment address the motivations needed to change behavior.
DRAUP in
Deadoption of CXR after US guided CVC confirmation
Time frame: 24 months
Fidelity
Percentage of DRAUP non-adherence
Time frame: 24 months
Plan to share: Yes — IPD sharing upon request
Supporting information: Study protocol
No publications or documents are linked to this record.
This study is completed, as verified in Apr 2026. You cannot join it, but the record below documents what was studied.
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Washington University School of Medicine