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Sustainability of evidence-based practices in the management of infants with bronchiolitis in hospital settings - a
Victoria Ramsden1,2,3, Franz E Babl2,4,5, Stuart R Dalziel6,7
1Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia.
Insights
This study assessed the long-term effectiveness of interventions to reduce low-value care for infant bronchiolitis. Findings will inform sustainable de-implementation strategies in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Implementation Science
- Health Services Research
Background:
- De-implementation of low-value practices in pediatric care requires further understanding.
- The Paediatric Research in Emergency Departments International CollaboraTive (PREDICT) Bronchiolitis Knowledge Translation (KT) Study previously reduced five low-value practices for infant bronchiolitis by 14.1% using targeted interventions.
- Sustainability of these practice changes remains unclear.
Purpose of the Study:
- To determine the sustained impact of interventions on reducing low-value bronchiolitis care two years after study support removal.
- To assess one-year sustainability of reduced low-value practices.
- To evaluate improvements in control hospitals and explore factors influencing sustainability.
Main Methods:
- A mixed-methods approach combining retrospective medical record audits and semi-structured interviews.
- Quantitative data from 1800 infants (intervention and control sites) collected at one and two years post-intervention to assess composite scores for low-value practices.
- Qualitative data from 78-130 healthcare professionals to explore factors influencing sustainability and practice change.
Main Results:
- This section is to be filled once the study results are available.
Conclusions:
- This research will enhance understanding of sustained evidence-based management for infant bronchiolitis.
- Findings will inform future de-implementation strategies to reduce low-value practices in pediatric acute care.
- The study contributes to advancing implementation science in pediatric healthcare settings.
Background:
Understanding how and why de-implementation of low-value practices is sustained remains unclear. The Paediatric Research in Emergency Departments International CollaboraTive (PREDICT) Bronchiolitis Knowledge Translation (KT) Study was a cluster randomised controlled trial conducted in 26 Australian and New Zealand hospitals (May-November 2017). Results showed targeted, theory-informed interventions (clinical leads, stakeholder meetings, train-the-trainer workshop, targeted educational package, audit/feedback) were effective at reducing use of five low-value practices for bronchiolitis (salbutamol, glucocorticoids, antibiotics, adrenaline and chest x-ray) by 14.1% in acute care settings. The primary aim of this study is to determine the sustainability (continued receipt of benefits) of these outcomes at intervention hospitals two-years after the removal of study supports. Secondary aims are to determine sustainability at one-year after removal of study support at intervention hospitals; improvements one-and-two years at control hospitals; and explore factors that influence sustainability at intervention hospitals and contribute to improvements at control hospitals.
Methods:
A mixed-methods study design. The quantitative component is a retrospective medical record audit of bronchiolitis management within 24 hours of emergency department (ED) presentations at 26 Australian (n = 20) and New Zealand (n = 6) hospitals, which participated in the PREDICT Bronchiolitis KT Study. Data for a total of 1800 infants from intervention and control sites (up to 150 per site) will be collected to determine if improvements (i.e., no use of all five low-value practices) were sustained two- years (2019) post-trial (primary outcome; composite score); and a further 1800 infants from intervention and control sites will be collected to determine sustained improvements one- year (2018) post-trial (secondary outcome). An a priori definition of sustainability will be used. The qualitative component will consist of semi-structured interviews with three to five key emergency department and paediatric inpatient medical and nursing staff per site (total n = 78-130). Factors that may have contributed to sustaining outcomes and/or interventions will be explored and mapped to an established sustainability framework.
Discussion:
This study will improve our understanding of the sustainability of evidence-based bronchiolitis management in infants. Results will also advance implementation science research by informing future de-implementation strategies to reduce low-value practices and sustain practice change in paediatric acute care.
Trial Registration:
Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.
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