Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with bronchiolitis

Meredith L Borland^{1

2}, Sharon O'Brien^{3

4}, Emma Tavender^{5

6}, Libby Haskell^{7

8}, Franz E Babl^{9

10}, Rachel Schembri^{11

12}, Ben Smedley¹³, Hugh Mitenko^{14

15}, Tim Robertson¹⁶, Ashes Mukherjee¹⁷, Stuart R Dalziel^{18

19}

Affiliations

¹ Paediatric Emergency Physician, Perth Children's Hospital, Nedlands, Western Australia, Australia.
² School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia.
³ Emergency Research Nurse Coordinator, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁴ School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
⁵ Implementation Scientist, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁶ Departments of Paediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.
⁷ Paediatric Emergency Nurse Practitioner, Starship Children's Hospital, Auckland, New Zealand.
⁸ Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
⁹ Paediatric Emergency Physician, Royal Children's Hospital, Parkville, Victoria, Australia.
¹⁰ Murdoch Children's Research Institute, Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.
¹¹ Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
¹² Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
¹³ Emergency Physician, Rockingham General Hospital, Cooloongup, Western Australia, Australia.
¹⁴ Emergency Physician, Bunbury Regional Hospital, Bunbury, Western Australia, Australia.
¹⁵ Clinical Senior Lecturer, Rural Clinical School, University of Western Australia, Perth, Western Australia, Australia.
¹⁶ Paediatric Trainee, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁷ Emergency Physician, Armadale Health Service, Mount Nasura, Western Australia, Australia.
¹⁸ Paediatric Emergency Physician, Starship Children's Hospital, Auckland, New Zealand.
¹⁹ Cure Kids Chair of Child Health Research, Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.

PMID: 37026175
DOI: 10.1111/apa.16786

Multicenter Study

Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with bronchiolitis

Meredith L Borland et al. Acta Paediatr. 2023 Aug.

. 2023 Aug;112(8):1747-1754.

doi: 10.1111/apa.16786. Epub 2023 Apr 18.

Authors

Affiliations

¹ Paediatric Emergency Physician, Perth Children's Hospital, Nedlands, Western Australia, Australia.
² School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia.
³ Emergency Research Nurse Coordinator, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁴ School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
⁵ Implementation Scientist, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁶ Departments of Paediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.
⁷ Paediatric Emergency Nurse Practitioner, Starship Children's Hospital, Auckland, New Zealand.
⁸ Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
⁹ Paediatric Emergency Physician, Royal Children's Hospital, Parkville, Victoria, Australia.
¹⁰ Murdoch Children's Research Institute, Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.
¹¹ Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
¹² Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
¹³ Emergency Physician, Rockingham General Hospital, Cooloongup, Western Australia, Australia.
¹⁴ Emergency Physician, Bunbury Regional Hospital, Bunbury, Western Australia, Australia.
¹⁵ Clinical Senior Lecturer, Rural Clinical School, University of Western Australia, Perth, Western Australia, Australia.
¹⁶ Paediatric Trainee, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁷ Emergency Physician, Armadale Health Service, Mount Nasura, Western Australia, Australia.
¹⁸ Paediatric Emergency Physician, Starship Children's Hospital, Auckland, New Zealand.
¹⁹ Cure Kids Chair of Child Health Research, Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.

PMID: 37026175
DOI: 10.1111/apa.16786

Abstract

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.

Keywords: acute bronchiolitis; audit; implementation; national guidelines.

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Comment on

Guideline implementation research is essential to improve management of common diseases such as infant bronchiolitis.
Korppi M. Korppi M. Acta Paediatr. 2023 Aug;112(8):1806-1807. doi: 10.1111/apa.16809. Epub 2023 May 9. Acta Paediatr. 2023. PMID: 37128926 No abstract available.

References

REFERENCES

1. Babl FE, Borland M, Ngo PK, et al. Paediatric research in emergency departments international collaborative (predict). J Paediatr Child Health. 2005;41(11):614-615.
1. Haskell L, Tavender EJ, Wilson C, et al. Implementing evidence-based practices in the care of infants with bronchiolitis in Australasian acute care settings: study protocol for a cluster randomised controlled study. BMC Pediatr. 2018;18(1):218.
1. Oakley E, Borland M, Neutze J, et al. Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013;1(2):113-120.
1. O'Brien S, Borland ML, Cotterell E, et al. Australasian bronchiolitis guideline. J Paediatr Child Health. 2019;55(1):42-53.
1. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801-1802.

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Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with bronchiolitis

Affiliations

Evaluation of targeted implementation interventions for reducing investigations and therapies in infants with bronchiolitis

Authors

Affiliations

Abstract

Comment on

References

REFERENCES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous