Implementing evidence-based practices in the care of infants with bronchiolitis in Australasian acute care settings:
Libby Haskell1,2, Emma J Tavender3,4, Catherine Wilson3
1Children's Emergency Department, Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand. libbyh@adhb.govt.nz.
Insights
This study evaluated knowledge translation interventions to reduce unnecessary treatments for infant bronchiolitis. Tailored interventions improved adherence to evidence-based care, reducing ineffective therapies in hospitalized infants.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Implementation science
Background:
- Bronchiolitis is a leading cause of infant hospitalization.
- Clinical practice variations exist, leading to ineffective therapies for infants.
- Evidence-based guidelines for bronchiolitis management are not consistently followed.
Purpose of the Study:
- To test the effectiveness of tailored, theory-informed knowledge translation (KT) interventions.
- To decrease the use of five specific therapies (salbutamol, antibiotics, glucocorticoids, adrenaline, chest X-ray) lacking evidence in bronchiolitis.
- To increase compliance with evidence-based recommendations within 24 hours of hospital presentation.
Main Methods:
- Cluster randomized controlled trial across 24 Australian and New Zealand hospitals.
- Intervention group received tailored KT strategies, including stakeholder meetings and staff education.
- Control group received standard guideline dissemination.
- Data collected retrospectively and during the intervention year to assess compliance.
Main Results:
- The study aims to establish the effectiveness of KT interventions in increasing compliance.
- It will measure the reduction in the use of five non-beneficial therapies.
- Data collection will assess fidelity to implementation and facilitate economic evaluation.
Conclusions:
- This study will determine the effectiveness of tailored KT interventions in pediatric acute care.
- It aims to reduce evidence-to-practice gaps in infant bronchiolitis management.
- Findings will inform strategies to improve adherence to evidence-based care.
Background:
Bronchiolitis is the most common reason for admission to hospital for infants less than one year of age. Although management is well defined, there is substantial variation in practice, with infants receiving ineffective therapies or management. This study will test the effectiveness of tailored, theory informed knowledge translation (KT) interventions to decrease the use of five clinical therapies or management processes known to be of no benefit, compared to usual dissemination practices in infants with bronchiolitis. The primary objective is to establish whether the KT interventions are effective in increasing compliance to five evidence based recommendations in the first 24 h following presentation to hospital. The five recommendations are that infants do not receive; salbutamol, antibiotics, glucocorticoids, adrenaline, or a chest x-ray.
Methods/Design:
This study is designed as a cluster randomised controlled trial. We will recruit 24 hospitals in Australia and New Zealand, stratified by country and provision of tertiary or secondary paediatric care. Hospitals will be randomised to either control or intervention groups. Control hospitals will receive a copy of the recent Australasian Bronchiolitis Guideline. Intervention hospitals will receive KT interventions informed by a qualitative analysis of factors influencing clinician care of infants with bronchiolitis. Key interventions include, local stakeholder meetings, identifying medical and nursing clinical leads in both emergency departments and paediatric inpatient areas who will attend a single education train-the-trainer day to then deliver standardised staff education with the training materials provided and coordinate audit and feedback reports locally over the study period. Data will be extracted retrospectively for three years prior to the study intervention year, and for seven months of the study intervention year bronchiolitis season following intervention delivery to determine compliance with the five evidence-based recommendations. Data will be collected to assess fidelity to the implementation strategies and to facilitate an economic evaluation.
Discussion:
This study will contribute to the body of knowledge to determine the effectiveness of tailored, theory informed interventions in acute care paediatric settings, with the aim of reducing the evidence to practice gaps in the care of infants with bronchiolitis.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12616001567415 (retrospectively registered on 14 November 2016).
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