Abstract：
Trans-radial artery access (TRA) for cardiac catheterization and percutaneous coronary intervention has many advantages over trans-femoral artery access (TFA), but implementation has been slow. The steep learning curve, logistical issues, and radiation exposure have been documented as barriers to implementation. Although many cardiac catheterization laboratories have overcome these barriers, we lack evidence on effective implementation strategies. Our objective is to test a team-based coaching intervention that targets the learning curve and other barriers to increase use of TRA. We use a stepped-wedge cluster-randomized trial to test a coaching intervention in Department of Veterans Affairs cardiac catheterization laboratories. The coaching intervention comprises team-based didactic instruction with live observation at a TRA-proficient lab, followed by a visit from a cardiologist and catheterization laboratory nurse coaching team. Interview and survey data are collected from participants to test and adapt an implementation science framework known as the Promoting Action on Research Implementation in Health Services (PARIHS) framework. This study is designed to test the effectiveness of the coaching intervention on TRA implementation, inform changes to the coaching intervention itself, and test and adapt the PARIHS framework in practice. While the benefits of TRA, including increased clinical efficiency, patient comfort, and reduced patient complications, are well understood, the underlying drivers of TRA adoption and sustained practice are not. Findings from this trial can inform future research to facilitate change in the cardiac catheterization laboratory.
摘要：
经桡动脉入路(TRA)用于心导管插入术和经皮冠状动脉介入治疗与经股动脉入路(TFA)相比具有许多优势,但实施缓慢。陡峭的学习曲线，后勤问题,和辐射暴露已被证明是实施的障碍。尽管许多心导管实验室已经克服了这些障碍，我们缺乏有效实施战略的证据。我们的目标是测试基于团队的教练干预措施，该措施针对学习曲线和其他障碍，以增加TRA的使用。我们使用阶梯式楔形集群随机试验来测试退伍军人事务部心脏导管插入实验室的指导干预。教练干预包括基于团队的教学指导，并在精通TRA的实验室进行实时观察，随后是心脏病专家和导管插入实验室护士教练团队的访问。从参与者那里收集访谈和调查数据，以测试和调整称为卫生服务研究实施促进行动（PARIHS）框架的实施科学框架。本研究旨在测试教练干预对TRA实施的有效性，告知教练干预本身的变化，并在实践中测试和适应PARIHS框架。虽然TRA的好处，包括提高临床效率，患者舒适度,减少患者并发症，很好理解，采用TRA和持续实践的潜在驱动因素并非如此。这项试验的结果可以为未来的研究提供信息，以促进心脏导管实验室的改变。
