Knowledge Translation in Australasian Paediatric Acute Care Settings: a multi-centred, cluster-randomised controlled trial comparing a tailored, theory informed Knowledge Translation intervention versus passive dissemination of a bronchiolitis guideline.

The intervention components will be tailored to the factors influencing practice (barriers and enablers) and the specific needs of intervention sites. Currently a qualitative study of emergency and paediatric medical and nursing staff concerning the barriers and enablers to appropriate bronchiolitis management is being undertaken by the research team and will be analysed in October, this will help refine content and range of interventions. To date, it is planned that the interventions will involve: Local stakeholder meetings - Central research team will meet with site Principal Investigator and potential staff to be champions (clinical opinion leaders) on two scheduled occasions to (i) check understanding of the study and capacity to be involved (ii) Negotiate implementation of the intervention with discussion of particular site related issues that are predicted. These meetings are important for engagement with the study team. Key outcomes will be recorded on a site checklist. Identification of nursing and medical clinical opinion leaders in each site in the ED and general paediatric area. - These people will be nominated by the sites according to a role description – provided by the central research team. It is requested to have an ED based nurse and doctor opinion leader and a General Paediatrics nurse and doctor opinion leader, details of each will be recorded. A one-day train-the-trainer workshop (1 or 2 to be held depending on availability of staff and site recruitment dates) - Site local opinion leaders from intervention sites will be invited to attend this one day training event. Two events may be held to capture groups in New Zealand and Australia. The day will have a workshop format of small interactive group sessions and lectures. Topics will be include: scientific evidence behind the PREDICT Australasian Bronchiolitis Guideline, evidence of how to change clinician behaviour, their role as a local opinion leader, content of interventions designed to change bronchiolitis management behaviour. Attendance will be recorded. Standardised education and interactive workshops delivered by the site based clinical leaders/champions over a 3 month period of time to their departmental staff. - This will involve the use of standardised power point presentations of the evidence basis for bronchiolitis management delivered in small group presentations at the site. Frequency of these sessions can only be determined by the site but this will be recorded as well as attendance. Sites will be encouraged to complete training of 80% of their staff within the first 4 weeks. The remaining staff will receive training as soon as possible. Sites will choose whether this is done in small groups, on an individual basis or a combination of these methods. All training will be recorded. Provision of materials to increase the visibility of tools - This may include provision of posters, clinical pathways, and standardised email reminders by the central research team to the site that contain highly visible reminders of desired bronchiolitis care. Non-specific reminders to optimise data collection - The research team member associated with each site will be in regular (at least 2 weekly) contact (email or phone) with the local champions to provide support and answer any queries. Discussion regarding data collection and offering assistance as required will be made. All contact made with sites will be recorded. Audit and feedback process undertaken at sites - All sites will be recommended to undertake auditing of the care of 10-12 randomly selected bronchiolitis patients once per fortnight over the bronchiolitis season. The required audit data to be retrieved from records and will be entered into an online database. The blinded data will be presented to sites showing their performance in comparison to other sites. It will also be encouraged that this audit and feedback information be used in training workshops to inform staff of their performance. General support provided by the central research team. - The central research team will contact each site on a 2 weekly basis from 1/5/17 to 30/11/17 to monitor progress and provide individualised support as issues arise. The central research team will record this information in a site contact log.