{
  "abstract": "Background 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).Methods 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.Results 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.Conclusion 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.Trial registration number Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.",
  "authors": [
    {
      "affiliations": [
        "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"
      ],
      "name": "Victoria Ramsden"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Franz E Babl"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Libby Haskell"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia"
      ],
      "name": "Catherine Wilson"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Elizabeth McInnes"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Sandy Middleton"
    },
    {
      "affiliations": [
        "School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia"
      ],
      "name": "Lisa Kuhn"
    },
    {
      "affiliations": [
        "Department of Paediatrics: Child and Youth Health, University of Auckland - City Campus, Auckland, New Zealand",
        "Depatment of Paediatrics, Waikato Hospital, Hamilton, New Zealand"
      ],
      "name": "Alexandra Wallace"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia",
        "Emergency Department, Grampians Health, Ballarat, Victoria, Australia"
      ],
      "name": "Elyssia Bourke"
    },
    {
      "affiliations": [
        "Emergency Research, The Prince Charles Hospital, Chermside, Queensland, Australia",
        "Northside Clinical School of Medicine, The University of Queensland, Chermside, Queensland, Australia"
      ],
      "name": "Faye Jordan"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia"
      ],
      "name": "Julian Wong"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Hawke’s Bay Hospital, Hastings, New Zealand"
      ],
      "name": "Kai Steinmann"
    },
    {
      "affiliations": [
        "Paediatric Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia"
      ],
      "name": "Lauren Shumack"
    },
    {
      "affiliations": [
        "The University of Queensland Faculty of Medicine, Herston, Queensland, Australia",
        "Department of Paediatrics, Caboolture Hospital, Caboolture, Queensland, Australia"
      ],
      "name": "Lisa Kane"
    },
    {
      "affiliations": [
        "Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia",
        "Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia"
      ],
      "name": "Natalie Phillips"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia"
      ],
      "name": "Paige Marsh"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Shefali Jani"
    },
    {
      "affiliations": [
        "Emergency Department, Christchurch Hospital, Christchurch, Canterbury, New Zealand"
      ],
      "name": "Trevor Kuang"
    },
    {
      "affiliations": [
        "Emergency Department, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia"
      ],
      "name": "Yvonne Janiszewski"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Ed Oakley"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia"
      ],
      "name": "Anna Lithgow"
    },
    {
      "affiliations": [
        "Healthy Brain and Mind Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia"
      ],
      "name": "Peter Wilson"
    },
    {
      "affiliations": [
        "Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia"
      ],
      "name": "Rachel Schembri"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Stuart Dalziel"
    },
    {
      "affiliations": [
        "Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia",
        "Department of Paediatrics and Critical Care, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia"
      ],
      "name": "Emma Tavender"
    }
  ],
  "title": "Understanding factors influencing sustainability and sustainment of evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation",
  "uid": "cca1e1c9-8d18-53b7-a772-bc26e52ad805"
}