LAUSR

Study design: Multicentre cluster randomised clinical trial. Setting: 26 hospitals in Australia (n=20) and New Zealand (n=6). 13 hospitals were randomised to the intervention group and 13 to control in the 2017 bronchiolitis season (with representation of secondary and tertiary hospitals from each country within both groups following stratification). Retrospective data from three bronchiolitis seasons prior to the trial (2014–2016) were additionally collected. Interventions: Targeted interventions were developed based on behaviour change theories (specifically the ’Theoretical Domains Framework’), following a qualitative study which identified local barriers and enablers to evidencebased bronchiolitis care. Interventions included: appointment of medical and nursing clinical leads, stakeholder meetings, trainthetrainer workshops, focused educational delivery (via PowerPoint presentation conveying scripted messages specifically designed to promote behavioural change), supplemental educational materials (clinician training videos, parent/caregiver information sheets), audit and feedback. Control: Hospitals disseminated the relevant (2016) Australasian Bronchiolitis Guideline as they wished; no other suggestions made as to management of bronchiolitis. Primary outcome: The proportion of infants who complied with all five of the Australasian Bronchiolitis Guideline recommendations known to have no benefit (avoidance of chest radiography, alongside no salbutamol, corticosteroid, epinephrine or antibiotic use) in the first 24 hours of hospitalisation. Secondary outcomes: Duration of hospitalisation, intensive care admission, death. Main results: Authors demonstrated an improved guideline compliance rate during the first 24 hours of hospitalisation in the intervention hospitals (85%) versus control (73%; p<0.001), with no statistically significant difference in duration of hospitalisation or intensive care admission. Improvements were consistent across both emergency department (p=0.002) and inpatient (p=0.004) phases of care.