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Published on: February 5, 2019
Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with
Meredith L Borland1,2, Sharon O'Brien3,4, Emma Tavender5,6
1Paediatric Emergency Physician, Perth Children's Hospital, Nedlands, Western Australia, Australia.
Insights
Implementing targeted interventions improved bronchiolitis management in infants, reducing unnecessary treatments. This quality improvement study highlights the effectiveness of site-adapted strategies for better clinical practice.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Implementation Science
Background:
- Bronchiolitis is a common respiratory infection in infants, often leading to emergency department visits.
- Management frequently includes investigations and therapies with minimal proven benefit, increasing healthcare costs and potentially causing harm.
- Standardized guidelines exist but adherence can be challenging in diverse clinical settings.
Purpose of the Study:
- To assess the impact of locally adapted, targeted implementation interventions on bronchiolitis management.
- To reduce the use of ineffective investigations and therapies in emergency departments for infants with bronchiolitis.
- To improve adherence to clinical practice guidelines.
Main Methods:
- A multi-centered, quality improvement study was conducted across four grades of hospitals in Western Australia.
- An adapted implementation intervention package was applied to infants under one year with bronchiolitis.
- Compliance with guideline recommendations (avoiding investigations/therapies of minimal benefit) was compared pre- and post-intervention.
Main Results:
- A total of 900 infants were included (457 pre-intervention, 443 post-intervention).
- Overall compliance improved from 78.1% to 85.6% post-intervention (RD 7.4%).
- Significant improvements were noted in reducing salbutamol use (88.6% to 95.7%) and in hospitals with initially low compliance.
Conclusions:
- Site-adapted implementation interventions effectively improved adherence to bronchiolitis management guidelines.
- Hospitals with lower initial compliance showed the most substantial improvements.
- Guidance on adapting and utilizing interventions is crucial for sustainable practice change in pediatric care.
Aim:
To evaluate the impact of locally adapted targeted implementation interventions on bronchiolitis management through reduction in ineffective investigation and therapies within emergency departments.
Methods:
A multi-centred, quality improvement study in four different grades of hospitals in Western Australia that provide paediatric emergency and inpatient care. All hospitals incorporated an adapted implementation intervention package for infants under 1 year with bronchiolitis. The proportion whose care complied with guideline recommendations to not receive investigations and therapies of minimal benefit were compared to pre-intervention care in a previous bronchiolitis season.
Results:
A total of 457 infants in 2019 (pre-intervention) and 443 in 2021 (post-intervention) were included, with mean age of 5.6 months (SD 3.2, 2019; SD 3.0, 2021). In 2019, compliance was 78.1% versus 85.6% in 2021, RD 7.4 (95% CI -0.6; 15.5). The strongest evidence was reduced salbutamol use (compliance improvement: 88.6% to 95.7%, RD 7.1 95% CI (1.7; 12.4)). Hospitals initially at <80% compliance demonstrated greatest improvements (Hospital 2: 95 (78.5%) to 108 (90.8%) RD 12.2 95% CI (3.3; 21.2); Hospital 3: 67 (62.6%) to 63 (76.8%) RD 14.2 95% CI (1.3; 27.2)).
Conclusion:
Targeted site-adapted implementation interventions resulted in improvement in compliance with guideline recommendations, particularly for those hospitals with initial low compliance. Maximising benefits through guidance on how to adapt and effectively use interventions will enhance sustainable practice change.
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