Understanding factors influencing sustainability and sustainment of evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation.

2025-10-05

Ramsden, Victoria

Babl, Franz E

Haskell, Libby

Wilson, Catherine

McInnes, Elizabeth

Middleton, Sandy

Kuhn, Lisa

Wallace, Alexandra

Bourke, Elyssia

Jordan, Faye

Wong, Julian

Steinmann, Kai

Shumack, Lauren

Kane, Lisa

Phillips, Natalie

Marsh, Paige

Jani, Shefali

Kuang, Trevor

Janiszewski, Yvonne

Oakley, Ed

Lithgow, Anna

Wilson, Peter

Schembri, Rachel

Dalziel, Stuart

Tavender, Emma

Nursing Research Institute, St Vincent's Health Network Sydney, Australia; St Vincent's Hospital Melbourne, Australia, Australian Catholic University, Darlinghurst, New South Wales, Australia.

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia.

Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.

Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia.

Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Auckland, Auckland, New Zealand.

Children's Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand.

Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Nursing Research Institute, St Vincent's Health Network Sydney, Australia; St Vincent's Hospital Melbourne, Australia, Australian Catholic University, Darlinghurst, New South Wales, Australia.

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia.

Nursing Research Institute, St Vincent's Health Network Sydney, Australia; St Vincent's Hospital Melbourne, Australia, Australian Catholic University, Darlinghurst, New South Wales, Australia.

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia.

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.

Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Auckland, New Zealand.

Depatment of Paediatrics, Waikato Hospital, Hamilton, New Zealand.

Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Emergency Department, Grampians Health, Ballarat, Victoria, Australia.

Emergency Research, The Prince Charles Hospital, Chermside, Queensland, Australia.

Northside Clinical School of Medicine, The University of Queensland, Chermside, Queensland, Australia.

Department of Emergency Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia.

Department of Paediatrics, Hawke's Bay Hospital, Hastings, New Zealand.

Paediatric Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

The University of Queensland Faculty of Medicine, Herston, Queensland, Australia.

Department of Paediatrics, Caboolture Hospital, Caboolture, Queensland, Australia.

Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.

Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.

Department of Emergency Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia.

Department of Emergency Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.

Faculty of Medicine and Health, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia.

Emergency Department, Christchurch Hospital, Christchurch, Canterbury, New Zealand.

Emergency Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.

Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.

Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia.

Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.

Healthy Brain and Mind Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia.

Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia.

Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Auckland, Auckland, New Zealand.

Children's Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand.

Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia emma.tavender@mcri.edu.au.

Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia.

Emergency department

Evidence-based medicine

Implementation science

Paediatrics

Journal Article

Publication

0000-0002-4376-4508

0000-0002-0567-9679

0000-0002-7201-4394

0000-0002-7230-712X

The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment).Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation.50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally.This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting.Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

link

BMJ Qual Saf . 2025 Oct 5:bmjqs-2025-019007. doi: 10.1136/bmjqs-2025-019007. Online ahead of print.

2044-5423

https://pubmed.ncbi.nlm.nih.gov/41047228/?otool=iaurydwlib