Educational and Feedback Interventions for Bronchiolitis
Recruiting in Palo Alto (17 mi)
+43 other locations
Age: Any Age
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Children's Hospital of Philadelphia
Disqualifiers: Apnea, Cardiac disease, Cancer, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The purpose of this study is to identify the optimal deimplementation strategies for an overused practice: continuous pulse oximetry monitoring of children hospitalized with bronchiolitis who are not receiving supplemental oxygen.
Do I need to stop my current medications to join the trial?
The trial information does not specify whether participants need to stop taking their current medications.
What data supports the effectiveness of the treatment Educational and Feedback Interventions for Bronchiolitis?
Research shows that using a clinical pathway, which is a structured plan of care, can reduce readmission rates for bronchiolitis and improve outcomes for other conditions like pneumonia. Integrated care pathways help reduce unnecessary treatments and continuously improve care quality by regularly updating practices based on the latest evidence.
12345Is the educational and feedback intervention for bronchiolitis safe for humans?
The research articles reviewed do not provide specific safety data for educational and feedback interventions, but they focus on improving clinical practices and patient care, which suggests a focus on safety and quality improvement.
678910How does the treatment 'Educational and Feedback Interventions for Bronchiolitis' differ from other treatments for bronchiolitis?
This treatment is unique because it focuses on educating healthcare providers and giving feedback to improve the management of bronchiolitis, rather than using medications. It aims to reduce unnecessary treatments and antibiotic overuse by standardizing care through evidence-based guidelines.
24111213Eligibility Criteria
The EMO Trial is for English-speaking nurses, physicians, and hospital administrators who have cared for bronchiolitis patients. It includes infants and children aged 2-23 months hospitalized with a primary diagnosis of bronchiolitis on non-ICU wards. Exclusions are extreme prematurity, cardiac disease, chronic lung conditions, immunodeficiency or current severe illness like COVID-19.Inclusion Criteria
I last used supplemental oxygen more than an hour ago.
Their child had their oxygen levels monitored while breathing normal air during Aim 1 data collection.
Employed full-time by the hospital, affiliated practice, or affiliated university
+11 more
Exclusion Criteria
I have a neuromuscular disease.
I have a weakened immune system.
I have or might have COVID-19 or its related severe complications.
+11 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Deimplementation Strategy Implementation
Implementation of deimplementation strategies including educational outreach, audit & feedback, and electronic health record-integrated clinical pathways
Up to 3 years
Sustainability Monitoring
Monitoring the sustainability of guideline-concordant deimplementation of continuous pulse oximetry monitoring
3 years
Follow-up
Participants are monitored for safety and effectiveness after deimplementation strategies
4 years
Participant Groups
This study tests strategies to reduce unnecessary continuous pulse oximetry monitoring in children with bronchiolitis not needing supplemental oxygen. Interventions include educational outreach, audit & feedback at unit and individual levels, and integrating clinical pathways into electronic health records.
2Treatment groups
Experimental Treatment
Active Control
Group I: Unlearning + SubstitutionExperimental Treatment4 Interventions
Includes educational outreach, audit \& feedback, and an electronic health record-integrated clinical pathway to support appropriate use of pulse oximetry.
Group II: Unlearning OnlyActive Control3 Interventions
Includes educational outreach and audit \& feedback.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Northwestern UniversityChicago, IL
University of PennsylvaniaPhiladelphia, PA
Children's National Medical CenterWashington, United States
Valley Children's HospitalMadera, CA
More Trial Locations
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Who Is Running the Clinical Trial?
Children's Hospital of PhiladelphiaLead Sponsor
National Heart, Lung, and Blood Institute (NHLBI)Collaborator
University of PennsylvaniaCollaborator
Boston Children's HospitalCollaborator
Children's Hospital Medical Center, CincinnatiCollaborator
Pediatric Research in Inpatient Settings (PRIS) NetworkCollaborator
References
Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia. [2019]To examine the impact of a unique evidence-based clinical pathway on six outcomes of care in patients hospitalized for community-acquired pneumonia (CAP).
Reducing Unnecessary Treatments for Acute Bronchiolitis Through an Integrated Care Pathway. [2022]To analyze the impact of an integrated care pathway on reducing unnecessary treatments for acute bronchiolitis.
Integrated care pathways: effective tools for continuous evaluation of clinical practice. [2022]The critical examination of clinical practice should be an integral part of patient care. It includes the development and implementation of guidelines, together with continuous evaluation of clinical process and outcomes to improve the quality of care provided. Clinical audit has not been successful in achieving this. The use of Integrated Care Pathways facilitates the introduction of guidelines and the continuous evaluation of clinical practice. Improvements are achieved by frequently revising the pathways to reflect current, local best practice. Integrated Care Pathways define the expected course of events in the care of a patient with a particular condition, within a set time-scale. A pathway is divided into time intervals during which specific goals and expected progress are defined, together with appropriate investigations and treatment. A pathway reflects the activities of a multidisciplinary team and can incorporate established guidelines and evidence-based medicine. It is usually unique to the institution in which it was developed. The pathway forms part of the clinical record of every patient. All variations from the pathway are documented, and the reasons for the variations analysed. Solutions are developed to address the causes of potentially avoidable variation, and the pathway is revised to incorporate these improvements. Integrated Care Pathways provide a powerful audit tool, as all aspects of the process and outcome of clinical practice can be constantly monitored. Variations from set standards are minimized, and improvements are rapidly incorporated into routine practice and subsequently re-evaluated.
A clinical pathway for bronchiolitis is effective in reducing readmission rates. [2022]To examine the use of a clinical pathway in the management of infants hospitalized with acute viral bronchiolitis.
Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation. [2021]Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness.
Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system. [2022]Audit and Feedback (A&F) is a widely used quality improvement technique that measures clinicians' clinical performance and reports it back to them. Computerised A&F (e-A&F) system interfaces may consist of four key components: (1) Summaries of clinical performance; (2) Patient lists; (3) Patient-level data; (4) Recommended actions. There is a lack of evidence regarding how to best design e-A&F interfaces; establishing such evidence is key to maximising usability, and in turn improving patient safety.
A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory. [2023]Audit and feedback is a common intervention for supporting clinical behaviour change. Increasingly, health data are available in electronic format. Yet, little is known regarding if and how electronic audit and feedback (e-A&F) improves quality of care in practice.
[A&F: obstacles to implementing interventions in the health system.] [2023]Understanding how well a clinician or health care team is performing provides an essential foundation for improvement. If done well, Audit and Feedback (A&F) provides data in non-judgemental, motivating insights and leads to changes in clinical processes that benefit patients. This article will explore obstacles to optimizing the potential positive effects of A&F to improve patient care and outcomes by examining three interrelated steps in the process: the audit; the feedback; and the action. The audit requires data that will be perceived as both valid and actionable. Acquiring and using such data properly often requires partnerships. Feedback recipients need to know how to turn data into action. The A&F, therefore, should include components that direct the recipient toward feasible next steps to undertake the change that will lead to improvement. The proposed actions may be individual (learning new diagnostic or therapeutic strategies, trying a more patient-centered approach, etc.) or organizational (more proactive approaches often including the involvement of additional team members). The ability to turn feedback into action will depend on the culture of the recipient-group, and its level of experience with these change processes. Feedback facilitation or coaching may be useful for some groups or certain kinds of desired changes in practice. Inadequate leadership and support for health professionals, as they try to respond to A&F, is also often a barrier. Finally, with the final focus on the challenges of the individual Work Packages (WP) within the Easy-Net network program, the article focuses on what were the facilitating and hindering factors, the obstacles encountered, and the resistance to change overcome, useful considerations in support of the increasingly widespread implementation of A&F activities in our Healthcare System in the future.
Reporting and design elements of audit and feedback interventions: a secondary review. [2018]Audit and feedback (A&F) is a frequently used intervention aiming to support implementation of research evidence into clinical practice with positive, yet variable, effects. Our understanding of effective A&F has been limited by poor reporting and intervention heterogeneity. Our objective was to describe the extent of these issues.
Validation of triggers and development of a pediatric trigger tool to identify adverse events. [2018]Little is known about adverse events (AEs) in pediatric patients. Record review is a common methodology for identifying AEs, but in pediatrics the record review tools generally have limited focus. The aim of the present study was to develop a broadly applicable record review tool to identify AEs in pediatric inpatients.
An evidence-based clinical pathway for bronchiolitis safely reduces antibiotic overuse. [2019]The overuse of antibiotics in the management of bronchiolitis is widely known, yet physician practice has been slow to change. We report here on the success of a clinical pathway in reducing antibiotic overuse in the inpatient management of bronchiolitis. The charts of 181 children admitted for bronchiolitis were reviewed to determine whether antibiotic use was reduced in patients managed using a clinical pathway compared with a matched group of patients managed without use of the pathway (non-pathway group). Only 9% of the pathway patients received antibiotics compared with 27% of the nonpathway group. No negative effects were seen on other quality measures including unplanned return for care. Furthermore, for patients managed using the clinical pathway, cost and length of stay were significantly reduced. Overall, the study suggests that implementation of a clinical pathway may be an effective means to change physician practice and reduce the unnecessary use of antibiotics, while maintaining or improving other aspects of quality of care.
Is slide-based or video-based eLearning better at achieving behavioural change in bronchiolitis management? A cluster-based randomised control trial. [2023]This cluster-based randomised control trial examines the comparative efficacy of two eLearning programs that teach clinicians evidence-based bronchiolitis management for children less than 12 months of age.
Standardizing the care of bronchiolitis. [2019]To study the effect of an educational intervention on the management of hospitalized infants with bronchiolitis.