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Understanding the uptake and adaption of targeted implementation interventions for reducing bronchiolitis
Tim Robertson1, Meredith L Borland1,2, Sharon O'Brien1,3
1Perth Children's Hospital, Nedlands, Western Australia, Australia.
Insights
This study examined how hospitals adapted interventions to reduce unnecessary treatments for infant bronchiolitis. Findings highlight the importance of local modifications for successful implementation in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Implementation Science
- Quality Improvement
Background:
- Infant bronchiolitis often leads to unnecessary investigations and therapies in emergency departments.
- Targeted implementation interventions have proven effective in reducing these practices.
- Understanding local adaptations is crucial for successful intervention uptake.
Purpose of the Study:
- To evaluate the adoption and local modifications of proven targeted implementation interventions.
- To assess how these interventions were adapted in Australian hospitals for infants with bronchiolitis.
- To identify factors influencing the adaptation process.
Main Methods:
- A multi-centered, mixed-methods quality improvement study was conducted in four Australian hospitals (May-December 2021).
- Hospitals received a standardized implementation intervention package and training.
- Real-time adaptation tracking logs and semi-structured interviews (n=12) were used, with interviews coded using FRAME-IS.
Main Results:
- A total of 23 adaptations were made to educational materials and interventions.
- Common modifications included shortening presentations, adding definitions, and formatting changes.
- Audit and feedback were utilized variably, with targeted teaching influencing adaptations.
Conclusions:
- Real-world analysis of adaptations provides valuable insights for de-implementation initiatives.
- Findings inform future national roll-out strategies for implementation packages in emergency departments.
- Local tailoring of interventions is key to successful de-implementation.
Aim:
To understand and evaluate the uptake and local adaptations of proven targeted implementation interventions that have effectively reduced unnecessary investigations and therapies in infants with bronchiolitis within emergency departments.
Methods:
A multi-centred, mixed-methods quality improvement study in four Australian hospitals that provide paediatric emergency and inpatient care from May to December 2021. All hospitals were provided with the same implementation intervention package and training. Real-time tracking logs of adaptions were completed followed by semi-structured interviews. Interviews were recorded, transcribed and subsequently coded using FRAME-IS to further describe the adaptions made.
Results:
Tracking logs were summarised and data from 12 interviews were compared from participating sites. The intervention resulted in 116 education sessions and a total of 23 adaptations made to educational materials, both content and contextual. Shortening education presentations, addition of bronchiolitis definitions, formatting of materials and novel interventions were the most common modifications. Audit and feedback were completed across all sites with varying utilisation. Targeted teaching was noted to dictate adaptions prior to and during implementation.
Conclusion:
Quantitative and qualitative analysis of clinical 'real-world' adaptations to proven targeted implementation interventions allows invaluable insight for future de-implementation initiatives and national roll-out of implementation packages in the ED setting.
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