None listed
Conditions
Brief summary
Respiratory illnesses are the most frequent reason for non-elective hospital admissions in children aged less than 5 years, with a high global health burden. Whilst mortality due to acute respiratory failure (ARF) has improved in high-income countries, mortality remains between 13-20% in less well-resourced settings. In Far North Queensland (Qld), 50% of mostly indigenous children with ARF require transfer to a tertiary hospital due to higher care needs, whereas in South-East Qld only 9-12% of these children require transfer. To address this inequality, we aim to introduce an evaluation of a measured model of care using a comprehensive respiratory care bundle for children with ARF in rural and remote hospitals in Qld. This includes the implementation of nasal high-flow therapy, which is a standard therapy used in regional and urban hospitals in Australia, but yet to be offered in a large number of rural and remote settings. We hypothesis that with the implementation of the respiratory care bundle we can reduce the number of children requiring interhospital transfers.
Interventions
The intervention is a Respiratory Care Bundle (RCB). The respiratory care bundle is a comprehensive educational bundle that is based on current standard Queensland Health clinical guidelines for bronchiolitis and Acute Respiratory Failure and use of nasal high-flow therapy in infants and children. The bundle incorporates evidence based on the recent randomised controlled trials (RCT’s) in Australia and New Zealand on these cohorts of infants and children and uses existing standard clinical gui
The intervention is a Respiratory Care Bundle (RCB). The respiratory care bundle is a comprehensive educational bundle that is based on current standard Queensland Health clinical guidelines for bronchiolitis and Acute Respiratory Failure and use of nasal high-flow therapy in infants and children. The bundle incorporates evidence based on the recent randomised controlled trials (RCT’s) in Australia and New Zealand on these cohorts of infants and children and uses existing standard clinical guidelines and practices used by Tertiary/Regional in South East Queensland ACTRN12613000388718, ACTRN1261800021079). The RCB will be applied to all children aged 0-4 years presenting to hospital with either bronchiolitis, reactive airway disease or pneumonia. The RCB is a care pathway for which nurses and doctors will receive education via face to face or where this is not possible via videoconference by the research team (study educators). Each education session consists of a 1–2-hour tutorial and all nurses and doctors in each hospital attending the study cohort will be trained. The RCB will be integrated into the mandatory education. The education will be provided in the Teaching phase of the study 4 weeks prior to the implementation phase. Each hospital will also have a local champion nurse who will provide on a daily base education and advice when necessary. Adherence to the RCB will be monitored by reviewing the medical records. For hospitals, which have not yet used Nasal High-Flow (NHF), additional education will be provided for use of NHF. This includes education on equipment, physiology of NHF therapy and patient specific application of NHF. The NHF equipment and consumables for each hospital will be provided as part of the study. The length of NHF therapy is dictated by each patient's condition and will be at the discretion of the attending clinician. The adherence to the NHF guidelines will be reviewed using the patient's medical record. The RCB will be implemented in a step wedged study design with each step having an interval of 5 months plus one month of education prior. 3-4 hospitals will be randomly allocated to the implementation phase at each of these steps, which allows that after 30 months all hospitals will use the RCB. An additional 12 months of post implementation data for all children admitted to the study sites will be collected to survey the adherence and sustainability of the RCB by reviewing the patient's medical record. An example of a care procedure that will be implemented as part of the RCB are the following: Once the patient is commenced on NHF therapy, it is at the discretion (dependent on the patient’s condition) of the referring clinician to nominate which level =/> 4 clinical services capability framework (CSCF) facility consultation will be sought from (Paediatrician in Cairns and/or Paediatric ICU consultant in Townsville - both Tertiary facilities). Retrieval Services Queensland (RSQ) may also be the first port of call if the clinician requires immediate consult as they can trigger consultation with both Cairns and Townsville. • Local nursing clinical leadership (Director of Nursing/ Nurse Unit Manager/ Clinical Nurse Coordinator/ Shift Team Leader) should be informed of the patient via regular patient status communication processes. • Consultation with the level =/>4 CSCF facility will be at 2hrs post commencement of NHF therapy or sooner if required. It is expected that consultation with the level =/> CSCF facility will have taken place within 4hrs of the NHF therapy being commenced. • If it is assessed at 2hrs, or earlier, post commencement of NHFC therapy that the patient may require transfer to a level =/>4 CSCF or higher facility, contact with RSQ will occur to inform the need or potential need of a retrieval. • If it is assessed at 2hrs post commencement of NHF therapy that the patient does not require transfer to a level =/> CSCF facility, consultation with the level =/>4 CSCF facility is still mandated to ensure the level =/>4 CSCF facility is aware of the patient and the patient’s condition.
Sponsors
Griffith University
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
No minimum to 4 Years
Healthy volunteers
No
Inclusion criteria
Infants with bronchiolitis admitted to hospital, aged <12 months with or without oxygen requirement, defined as acute onset of respiratory disease, presenting with increased respiratory rate, cough, increased work of breathing, rhinorrhoea, increased body temperature, widespread crackles or wheeze and reduced fluid intake. Children admitted to hospital aged 0-4 years with acute respiratory symptoms, presenting with increased respiratory rate, with or without oxygen requirement, with or without increased work of breathing and wheeze, increased body temperature and reduced fluid intake. Note, there are only few infants <12 months of age that are presenting to hospital with respiratory symptoms other than bronchiolitis.
Exclusion criteria
No formal patient exclusion criteria exist, as the intent of the study is to observe and audit all episodes when a child presents with acute respiratory failure, including bronchiolitis to one of the participating hospitals.
Outcome results
None listed