RT Journal Article SR Electronic T1 Algorithmic surveillance of ICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e045589 DO 10.1136/bmjopen-2020-045589 VO 11 IS 4 A1 Marx, Gernot A1 Bickenbach, Johannes A1 Fritsch, Sebastian Johannes A1 Kunze, Julian Benedict A1 Maassen, Oliver A1 Deffge, Saskia A1 Kistermann, Jennifer A1 Haferkamp, Silke A1 Lutz, Irina A1 Voellm, Nora Kristiana A1 Lowitsch, Volker A1 Polzin, Richard A1 Sharafutdinov, Konstantin A1 Mayer, Hannah A1 Kuepfer, Lars A1 Burghaus, Rolf A1 Schmitt, Walter A1 Lippert, Joerg A1 Riedel, Morris A1 Barakat, Chadi A1 Stollenwerk, André A1 Fonck, Simon A1 Putensen, Christian A1 Zenker, Sven A1 Erdfelder, Felix A1 Grigutsch, Daniel A1 Kram, Rainer A1 Beyer, Susanne A1 Kampe, Knut A1 Gewehr, Jan Erik A1 Salman, Friederike A1 Juers, Patrick A1 Kluge, Stefan A1 Tiller, Daniel A1 Wisotzki, Emilia A1 Gross, Sebastian A1 Homeister, Lorenz A1 Bloos, Frank A1 Scherag, André A1 Ammon, Danny A1 Mueller, Susanne A1 Palm, Julia A1 Simon, Philipp A1 Jahn, Nora A1 Loeffler, Markus A1 Wendt, Thomas A1 Schuerholz, Tobias A1 Groeber, Petra A1 Schuppert, Andreas YR 2021 UL http://bmjopen.bmj.com/content/11/4/e045589.abstract AB Introduction The acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure.Methods and analysis In this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested.Ethics and dissemination Ethical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals.Trial registration number DRKS00014330.