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

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.

Guideline implementation research is essential to improve management of common diseases such as infant bronchiolitis

“…On average, current compliance for bronchiolitis guidelines in Australia is so high that it is difficult to achieve any further improvement. Sites with lower compliance present with a greater effects size, which was seen also in the Australian study 1 . Knowledge of reasons for inappropriate compliance is essential.…”

“…In this issue of Acta Paediatrica, Meredith Borland et al publish their interesting results from Australia on the impact of locally adapted targeted de‐implementation interventions on bronchiolitis management 1 . Emergency departments of four different‐grade hospitals were included and seasonal periods in 2019 (pre‐intervention) and 2021 (post‐intervention) were surveyed.…”

“…The adjusted risk difference (RD) was 14.1 (6.5–21.7). The current study 1 evaluated the impact of the same de‐implementation protocol in real life.…”

“…First, I would like to congratulate the author's team, 1 not only for their results, but also for the high compliance with bronchiolitis guidelines of the attending hospitals already before intervention. Total compliance during the first 24 h after admission increased from 78.1% to 85.6% (RD 7.4%, 95% CI −0.6 to 15.5).…”

“…When five individual parameters were analysed separately, 1 compliance for not receiving salbutamol increased from 88.6% to 95.7% (RD 7.1, 95% CI 1.7–12.4). Adrenaline inhalations were not given to 99.8% versus 100.0%.…”