TY - JOUR T1 - Reporting on implementation trials with null findings: the need for concurrent process evaluation reporting JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2022-014693 SP - bmjqs-2022-014693 AU - Anne Sales Y1 - 2022/06/14 UR - http://qualitysafety.bmj.com/content/early/2022/06/14/bmjqs-2022-014693.abstract N2 - The Prioritising Responses of Nurses to deteriorating patient Observations (PRONTO) trial reported in this issue of BMJ Quality and Safety describes results of a trial that overall, despite a few positive findings among the large number of planned comparisons performed, produced results that supported rather than rejected the study null hypotheses.1 This is a disappointing result for the investigators, who put considerable time and energy into this study; for funders, who hoped to learn how to positively influence the quality and safety of nursing care for seriously ill adults; and for readers, who also hoped to learn how to influence and support high-quality care by ensuring that nurses activate support systems in response to patient deterioration in hospitals.The PRONTO trial was designed to assess the effectiveness of a combined internal and external facilitation implementation intervention compared with usual guideline dissemination in hospital inpatient acute care wards. The trial was conducted in four hospitals in Victoria, Australia, and a total of 36 inpatient wards were randomised to either the facilitation intervention or to usual dissemination. The goal of the guideline being implemented was to ensure that nurses react quickly and appropriately to changes in vital signs indicating that the patient’s condition was deteriorating. The measurements used in the study—which were numerous—were focused on measuring compliance with the complex clinical practice guideline of caring for patients with deteriorating condition, required for hospital accreditation. The guideline implemented in these four hospitals mandated three escalating levels of care for patients with deteriorating condition, the highest being activating the Cardiac Arrest Team, to be selected based on the clinical assessment of the nurse following changes in vital signs.The expectation of outcomes was that improving the implementation of the guideline would increase the frequency with which nurses trigger escalation in the level of … ER -