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Table 1 Bronchiolitis intervention components

From: Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management – a PREDICT mixed-methods study

Intervention
(timing of intervention)
Description and causal assumptions/rationale
Clinical leads
(February 2017)
Four clinical leads, including one nursing and one medical lead in each of the emergency department and paediatric inpatient units for duration of study.
Key tasks included attending train-the-trainer 1 day workshop, leading delivery of educational intervention and other educational materials to all staff, overseeing completion of monthly audit and delivery of feedback, and coordinating study requirements.
Rationale: Provide consistent credible, influential, and trustworthy leadership; increase knowledge and skills through education, influence and persuasion; clinical leads ensured interdisciplinary and interdepartmental coverage.
Stakeholder meeting
(February to March 2017)
Study team met with clinical leads to present Australasian Bronchiolitis Guideline, discuss international and local variation in bronchiolitis management, review local audit results, and discuss any anticipated local barriers, with the aim to gain buy-in.
Rationale: Create hospital buy-in; provide feedback on current management; knowledge of own practice variation is likely to drive change; increase knowledge of intervention process; identify and address any potential barriers.
Train-the-trainer workshop
(23 February 2017)
One-day workshop for clinical leads to discuss: Australasian Bronchiolitis Guideline and evidence underpinning recommendations, implementation, qualitative study identifying barriers and facilitators to bronchiolitis management, and development process of interventions. Demonstrated to clinical leads how to deliver educational intervention to their staff, outlined study data requirements and timeline, and facilitated planning time for clinical leads.
Rationale: Improve knowledge; change beliefs; optimise professional interdisciplinary and interdepartmental relationships; motivate clinical leads as drivers of change.
Educational intervention delivery
(1 May to 30 November 2017)
PowerPoint presentation designed with scripted messages addressing key findings from qualitative study using behaviour change techniques most likely to effect change.
Education delivery overseen by clinical leads to nursing and medical staff using PowerPoint presentation.
Aimed to train 80% of staff within first month and on-going education throughout duration of study ensuring all staff educated.
Rationale: Improve knowledge; increase skills; change beliefs; feedback on performance; address barriers and enablers to evidence-based management; reinforce importance of evidence-based management and consequences of not following recommendations; positive reinforcement.
Use of other educational materials
(1 May to 30 November 2017)
Clinician training video
Rationale: Demonstrate/role model clinician behaviour; increase skill; provide motivation.
Evidence fact sheets
Rationale: Improve knowledge; change beliefs of clinicians.
Promotional materials
Rationale: Reminder/prompt of recommended management; feedback on performance; provide motivation.
Parent/caregiver information
Rationale: Improve knowledge; increase skill and confidence; provide encouragement and support.
Audit and feedback
(1 May to 30 November 2017)
Monthly audits of the first 20 bronchiolitis presentations, with report produced showing individual hospital results compared with top-performing hospital. Report disseminated by clinical leads to their staff in verbal and written format; action planning with target setting encouraged.
Rationale: Provide real-time feedback on targeted behaviours; motivate by benchmarking; promote goal/target specific action planning to optimise on-going improvement; increase knowledge; change beliefs.