Knowledge Translation in Australasian Paediatric Acute Care Settings: a multi-centred, cluster-randomised controlled trial comparing a tailored, theory informed Knowledge Translation intervention versus passive dissemination of a bronchiolitis guideline.

INTERVENTION: The intervention components will be tailored to the factors influencing practice (barriers and enablers) and the specific needs of intervention sites. Currently a qualitative study of emergency and paediatric medical and nursing staff concerning the barriers and enablers to appropriate bronchiolitis management is being undertaken by the research team and will be analysed in October, this will help refine content and range of interventions. To date, it is planned that the interventions will involve: Local stakeholder meetings ‐ Central research team will meet with site Principal Investigator and potential staff to be champions (clinical opinion leaders) on two scheduled occasions to (i) check understanding of the study and capacity to be involved (ii) Negotiate implementation of the intervention with discussion of particular site related issues that are predicted. These meetings are important for engagement with the study team. Key outcomes will be recorded on a site checklist. Identification of nursing and medical clinical opinion leaders in each site in the ED and general paediatric area. ‐ These people will be nominated by the sites according to a role description – provided by the central research team. It is requested to have an ED based nurse and doctor opinion leader and a General Paediatrics nurse and doctor opinion leader, details of each will be recorded. A one‐day train‐the‐trainer workshop (1 or 2 to be held depending on availability of staff and site recruitment dates) ‐ Site local opinion leaders from intervention sites will be invited to attend this one day training event. Two events may be held to capture groups in New Zealand and Australia. The day will have a workshop format of small interactive group sessions and lectures. Topics will be include: scientific evidence behind the PREDICT Australasian Bronchiolitis Guideline, evidence of how to change clinician behaviour, their role as a local opinion leader, content of interventions designed to change bronchiolitis management behaviour. Attendance will be recorded. Standardised education and interactive workshops delivered by the site based clinical leaders/champions over a 3 month period of time to their departmental staff. ‐ This will involve the use of standardised power point presentations of the evidence basis for bronchiolitis management delivered in small group presentations at the site. Frequency of these sessions can only be determined by the site but this will be recorded as well as attendance. Sites will be encouraged to complete training of 80% of their staff within the first 4 weeks. The remaining staff will receive training as soon as possible. Sites will choose whether this is done in small groups, on an individual basis or a combination of these methods. All training will be recorded. Provision of materials to increase the visibility of tools ‐ This may include provision of posters, clinical pathways, and standardised email reminders by the central research team to the site that contain highly visible reminders of desired bronchiolitis care. Non‐specific reminders to optimise data collection ‐ The research team member associated with each site will be in regular (at least 2 weekly) contact (email or phone) with the local champions to provide support and answer any queries. Discussion regarding data collection and offering assistance as required will be made. All contact made with sites will be recorded. Audit and feedback process undertaken at sites General support provided by the central research team. CONDITION: Bronchiolitis ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ‐ All sites will be recommended to undertake auditing of the care of 10‐12 randomly selected bronchiolitis patients once per fortnight over the bronchiolitis season. The required audit data to be retrieved from records and will be entered into an online database. The blinded data will be presented to sites showing their performance in comparison to other sites. It will also be encouraged that this audit and feedback information be used in training workshops to inform staff of their performance. ‐ The central research team will contact each site on a 2 weekly basis from 1/5/17 to 30/11/17 to monitor progress and provide individualised support as issues arise. The central research team will record this information in a site contact log. PRIMARY OUTCOME: Compliance or non‐compliance for each individual patient presentation with the guideline, will be assessed through the review of medical records retrospectively. Records will be assessed with regards to the use of key therapies / management processes known to have no benefit (chest x‐ray, salbutamol, glucocorticoids, antibiotics, epinephrine), using a composite outcome, during the first 24 hours after presentation to the ED (acute care period). SECONDARY OUTCOME: Compliance or non‐compliance for each individual patient presentation will be assessed in relation to the guideline with regards to the use of key therapies / management processes known to have no benefit (chest x‐ray, salbutamol, glucocorticoids, antibiotics, epinephrine) ‐ during total ED and inpatient hospitalisation period. This is a composite outcome. Compliance will be assessed through review of medical records. ; Compliance or non‐compliance for each individual patient presentation will be assessed in relation to the guideline with regards to the use of key therapies / management processes known to have no benefit (chest x‐ray, salbutamol, glucocorticoids, antibiotics, epinephrine) ‐ whilst an inpatient outside of the ED. This is a composite outcome. Compliance will be assessed through review of medical records. ; Compliance or non‐compliance for each individual patient presentation will be assessed in relation to the guideline with regards to the use of key therapies / management processes known to have no benefit (chest x‐ray, salbutamol, glucocorticoids, antibiotics, epinephrine) ‐ whilst in the ED. This is a composite outcome and compliance will be assessed through review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during the first 24 hours following presentation to the ED (acute care period) with regards to the use of Antibiotics. Compliance will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during the first 24 hours following presentation to the ED (acute care period) with regards to the use of Chest x‐ray. Compliance will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during the first 24 hours following presentation to the ED (acute care period) with regards to the use of Epinephrine. Compliance will be assessed through the review of medical records. ; ; Death and or intensive care admission data will be assessed through the review of medical records. ; ; Hospital Length of stay data will be assessed through the review of medical records. ; ; ; Median number of medication doses given during the acute inpatient care period. This will be assessed through the review of medical records. ; ; Median number of medication doses given during the total period of hospitalisation. This will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during the first 24 hours following presentation to the ED (acute care period) with regards to the use of Glucocorticoids. Compliance will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during the first 24 hours following presentation to the ED (acute care period) with regards to the use of Salbutamol. Compliance will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during their total hospitalization with regards to use of Antibiotics. This will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during their total hospitalization with regards to use of Chest x‐ray. This will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during their total hospitalization with regards to use of Epinephrine. This will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during their total hospitalization with regards to use of Glucocorticoids. This will be assessed through the review of medical records. ; Compliance or non‐compliance for each patient presentation with guideline recommendations during their total hospitalization with regards to use of Salbutamol. This will be assessed through the review of medical records. ; Health care costs including cost associated with guideline development and implementation. Guideline costs will be assessed through the review of guideline development records that are directly available to the research team. Hospital health care costs will be assessed through medical records or informed through imputation conducted by a health economist consultant. ; ; ; Predictors of bronchiolitis management assessed through Clinician self‐report via survey at baseline and at the end of the 2017 bronchiolitis season. ; (c) Other cognitions such as knowledge and beliefs about capabilities (for bronchiolitis only) (Survey items designed for this study) ; ; Predictors of bronchiolitis management assessed through Clinician self‐report via survey at baseline and at the end of the 2017 bronchiolitis season. Survey is designed for this study. ; (a) Cognitions in relation to bronchiolitis‐related team climate (e.g. participative safety, support for innovation, vision, task orientation) (Team Climate Inventory, 12‐item short version) ; ; Predictors of bronchiolitis management assessed through Clinician self‐report via survey at baseline and at the end of the 2017 bronchiolitis season. Survey is designed for this study. ; (b) Intention to adhere to recommended practices for bronchiolitis ; ; Process evaluation including measurement of acceptability of the interventions at the site. This will be assessed by data collected by a staff survey after 30/11/2017. ; Process evaluation including measurement of delivery of interventions at the site. This will be assessed by data collected by the site (in study logs) and by the study team about interventions delivered, (eg. number of staff attending, number of audits conducted and cases audited, and number of times the database is accessed to input data). ; ; ; ; INCLUSION CRITERIA: Hospitals: 1. Have an ED census of >135 cases of bronchiolitis per year. 2. Be willing to participate (either in the control or intervention arm). 3. A signed department agreement by both ED and inpatient clinical directors. 4. Have the ability to collect the required retrospective patient data from clinical notes. Staff Cohort Medical * Current ED or general paediatric employee * On active practice roster * Registrars, House Officers (or equivalent) or consultants Nursing: * Current ED or general paediatric employee * On active practice roster * Registered or enrolled nurse Patient Medical Record Cohort 1. Aged less than 12 months (at time of presentation), AND 2. A recorded diagnosis of bronchiolitis on discharge from ED to home, OR 3. A diagnosis of bronchiolitis on discharge from inpatient area AND a recorded diagnosis of bronchiolitis in ED