238 - Understanding how to sustain evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation

Poster Number: 238
Publication Number: 238.2788

Background: Bronchiolitis is the leading cause of hospitalization in infants in developed countries. The Paediatric Research in Emergency Departments International Collaborative Knowledge Translation (PREDICT) Bronchiolitis knowledge translation (KT) Study, a cluster randomized control trial (cRCT) in 26 Australian and New Zealand hospitals, found targeted interventions over one bronchiolitis season (clinical leads, stakeholder meetings, train-the-trainer workshop, targeted education, promotional materials, audit/feedback) were effective at reducing the use of five low-value practices (albuterol, glucocorticoids, chest radiography (CXR), antibiotics, and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5%-21.7%; P < .001). However, understanding how to effectively sustain cessation of low-value care is limited.

Objective: To determine fidelity to and adaptation of the PREDICT Bronchiolitis KT Study implementation interventions at intervention hospitals four years post intervention delivery and identify factors that influenced the sustainability of improvements.

Design/Methods: Qualitative interviews were conducted with a purposive sample of nurses and doctors, from the emergency department and pediatric inpatient wards, at 12 of the 13 intervention hospitals enrolled in the cRCT, about their views on factors that influenced the sustainment of the implementation interventions. Data were analysed thematically using the Consolidated Sustainability Framework for Constructs in Healthcare.

Results: Fifty clinicians were interviewed. We found the original implementation interventions were not sustained in the original form, yet elements had been adapted into local contexts. Three major themes influenced sustainment of key messages from the implementation interventions: (i) the organizational setting; with sub-themes of: organizational values and culture; integration with existing policies and programs; and intervention adaptation and receptivity; (ii) the initiative design and delivery; with sub-themes of: training and capacity building; evidence base for the initiative; and project duration; and (iii) the people involved; with sub-themes of: leadership and champions; and staff involvement.

Conclusion(s): Low fidelity to the PREDICT Bronchiolitis KT implementation interventions suggests that adaptation of interventions to local contexts may be effective at sustaining improvements in bronchiolitis management. Incorporation of these key elements into future intervention design may sustain practice change in other clinical initiatives.