Abstract Introduction High-flow nasal oxygen (HFNO) reduces mortality in acute hypoxemic respiratory failure (AHRF), but delayed transition to mechanical ventilation in patients who ultimately require intubation can increase harm. Escalation criteria vary widely across clinicians. The ROX index offers an evidence-based framework to guide escalation, yet its use remains inconsistent. As part of a hospital-wide implementation initiative, we developed and iteratively refined an educational intervention to enhance internal medicine residents’ knowledge, confidence, and adherence to guideline-concordant HFNO use—serving as an early step in designing implementation strategies for an evidence-based HFNO algorithm for our health system. Methods Using key Consolidated Framework for Implementation Research (CFIR) domains such as intervention characteristics, inner setting, and process, we developed a theory-informed curriculum emphasizing evidence-based initiation, titration, and escalation of HFNO using the ROX index. The intervention was iteratively adapted after each implementation cycle based on resident feedback and barriers identified during interim analyses. Pre- and post-session surveys evaluated changes in objective knowledge, self-efficacy, and perceptions of guideline concordance. Independent two-sample t-tests and two-proportion z-tests were used for comparisons. Results At baseline, 98.4% of participants had never used the ROX index to guide HFNO use. Confidence in HFNO use increased from 65.5% pre-education to 82.8% post-education (p = 0.047). Knowledge improved from 47.5% to 60.7% (p = 0.12). Mean knowledge scores did not change significantly from January to July (53% vs. 51%, p = 0.3) but improved substantially after curriculum refinement from August to October (39% vs. 65%, p = 0.001). Conclusion An iteratively adapted, CFIR-informed educational intervention improved residents’ confidence and knowledge regarding HFNO use. Incorporating stakeholder feedback and contextual assessment supported refinement and improved uptake. To further identify determinants within the inner and outer setting influencing guideline-concordant HFNO use, we are conducting semi-structured interviews with clinicians. Findings will inform multilevel implementation strategies for the institution’s evidence-based HFNO algorithm. This abstract is funded by: None
Sarpong et al. (Fri,) studied this question.