Table 5 Implementation strategies in both arms of the proposed Supraglottic Airway for Resuscitation (SUGAR) hybrid trial

Implementation strategy (i.e., applicable ERIC category)

Description

Core function

Distribute educational materials;

Conduct educational meetings

Slide deck, posters, patient-facing materials, resuscitation checklist, videos distributed to sites

Expectation that site teams will educate neonatal resuscitation providers until they reach ≥ 80% of relevant staff

Sharing evidence and guidelines supporting SA use in both synchronous live and asynchronous recorded sessions;

Describing how to use SA during resuscitation

Identify and prepare champions

Each institution will name SUGAR champions from professional roles that involve placing or supporting placement of SA during neonatal resuscitation

Eliciting concerns or resistance to SA adoption from other clinicians and sharing those with local SUGAR leadership;

Promoting a positive attitude toward SA use;

Setting the tone locally that SA use is the new norm

Use train the-trainer strategies

Each site will nominate one site training lead to attend a half-day, in-person, hands-on “train the trainer” bootcamp convened during a well-attended national neonatal meeting. After the in-person training, each trainer will return to their institutions to conduct SA training educational sessions

Providing training in SA use to staff;

Strengthening skills and abilities and perceived behavioral control

Model and simulate change

Two detailed neonatal simulation scenarios and guides will be distributed to sites with expectation that they will conduct simulation training with neonatal resuscitation providers, reaching ≥ 50% of relevant staff

Providing training in SA use to staff;

Strengthening skills and abilities and perceived behavioral control

Change physical structure and equipment

SUGAR will provide each site with one 100-count SA starter pack for both training and clinical use. This is intended to be a bridge to each site working with their own supply chains to formalize stocking of Sas in the delivery room

Making SAs available in the delivery room

Enhanced—Plus Arm Only

Implementation strategy (i.e., applicable ERIC category)

Description

Core function

Assess for readiness and identify barriers and facilitators

Hybrid (3 remote meetings followed by a 2-day in-person site visit) facilitated by an experienced resuscitation expert from the central SUGAR team to facilitate launch of SUGAR with local partners and assess the site’s implementation readiness for implementation of SA use for early rescue

Assessing and facilitating problem-solving across readiness domains (e.g., organizational leadership support, staff engagement, unit stability, competing priorities)

Audit and provide feedback; Facilitation

Central SUGAR facilitators lead monthly 1-hour remote external facilitation sessions (2 meetings offered per month, with Site PI and at least 1 additional site SUGAR Champion expected to attend 1 per month)

Supporting each site to address barriers to SA adoption and penetration, taking context into account;

Facilitators work with sites to set implementation penetration goals and highlight additional metrics; Reviewing ongoing penetration data with interactive problem solving for sites with low or delayed penetration;

Addressing site-specific challenges in a group setting;

Developing local plans for long-term increased uptake and sustainment