Sustainability of evidence-based practices in the management of infants with bronchiolitis in hospital settings - a PREDICT study protocol

• Published in: BMC health services research Vol. 22; no. 1; pp. 1 - 1099
• Main Authors: Ramsden, Victoria, Babl, Franz E, Dalziel, Stuart R, Middleton, Sandy, Oakley, Ed, Haskell, Libby, Lithgow, Anna, Orsini, Francesca, Schembri, Rachel, Wallace, Alexandra, Wilson, Catherine L, McInnes, Elizabeth, Wilson, Peter H, Tavender, Emma
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 29-08-2022; BioMed Central; BMC
• Subjects: Acute care; Antibiotics; Bronchiolitis; Care and treatment; Diagnosis; Emergency medical care; Emergency medicine; Evidence-based medicine; Evidence-based practice; Health aspects; Health services; Infant health services; Intervention; Medical records; Methods; Paediatric; Patient admissions; Pediatrics; Practice; Study Protocol; Sustainability; Sustainable development; Sustainment, implementation science, evidence-based practice; Australia; New Zealand
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08450-z

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. Keywords: Sustainability, Sustainment, implementation science, evidence-based practice, Bronchiolitis, Acute care, Paediatric, Emergency medicine