Implementation of a strategy to facilitate effective medical follow-up for Australian First Nations children hospitalised with chest infections: study protocol

The intervention is implementation of a "strategy" to facilitate optimal follow-up for First Nations children hospitalised with acute lower respiratory tract infections (ALRIs). The strategy has seven core components for each site. The core components of the "strategy" include: 1. First Nations lead: appointed at each site to advise on all cultural components of project, ensure culturally secure operations with First Nations knowledge being privileged. A First Nations officer is available for all First Nations participants from recruitment to all participation components. Adherence is measured by a First Nations lead being appointed and employed for the duration of the study. 2. Stakeholder engagement - with with healthcare providers (HCPs) in hospitals and primary care, First Nations parents generate buy-in and ascertain and address local barriers and facilitators to implementation. Engagement occurs with in-person focus groups and interviews for the purpose of identifying current state, barriers and facilitators to providing the strategy. Qualitative experts (content expert and First Nations cultural expert, who are research team members) will lead the interviews and focus groups. Focus groups will be scheduled for 30-60 minutes, and interviews will be scheduled for 10-30minutes, with an expected single attendance only by participants. There is no limit to the number of attendees for focus groups, but numbers are not expected to exceed 25 per group based on size of departments. Stakeholder engagement can occur during the pre-intervention period (approximately 12-months). Adherence is measured via a written, published report summarising the key findings, process map and tailored implementation of strategy for each site. 3. Training of HCPs: (online modules, podcasts, in-person training). In-person training (1-hour duration x 2 occasions) will be scheduled for relevant HCPs during preferred departmental time allocation by managers. The on-line module will be promoted to all staff throughout the intervention period. The module takes 45 minutes to complete and is only completed once. The Podcast is 30-minutes and is intended for single listening and will be promoted throughout the intervention period. The podcast is intended for once only and is an additional resource, not primary form of teaching. In-person training is provided by a paediatric respiratory physician for doctors and/or paediatric respiratory clinician for other HCPs (e.g. physiotherapist or nurse). The cultural training is integrated into the 1-hour training session and is provided by a First Nations person. All trainers are part of the research team. Adherence is measured by metrics of completions at each site (electronic capture system) for online training and calculation of the percentage or proportion of HCPs trained out of the total number who could be trained at each site. 4. Educational resources (i)culturally secure Flipchart (developed with First Nations parents, consumer endorsed and used at Perth Children's Hospital (PCH) https://www.telethonkids.org.au/globalassets/media/documents/research-topics/wet-cough/acute-lung-sickness-2020_print1.pdf). The 10-page flip chart is written with simple language and pictures. Clinicians will use the tool to teach parents whose children are admitted with acute chest infections when doing routine ward rounds. The flip chart explains a child's acute respiratory illness and the risk of developing chronic lung disease and the need for medical follow-up at 1-month. It takes approximately 5-minutes to go through with the parent/carer. (ii) health facts pamphlet with discharge information for parent (PCH and consumer endorsed): This 1-page A4 sized document is a summarised version of the flip-chart with the key health message: See local clinic/doctor in 1-month following discharge to follow up on chronic wet cough. The pamphlet is provided by the hospital clinician (nurse, doctor, physiotherapist) during the discharge process and takes approximately 2-minutes to explain. The information is a brief repeat of the flip chart session. The pamphlet would take a parent 2-minutes to read also at a later date. (iii) letter to local clinic. The letter is for the local primary care doctor/clinician. It contains details of the child's admission (as per standard hospital practice), a link to the on-line training module on management of chronic wet cough, a request to review child at 1-month for ongoing respiratory symptoms, specifically chronic wet cough, with recommended treatment if cough persists. A paper copy of the letter is given to the parent (takes approximately 1-minute as instruction is to give to local clinic) with the information pamphlet and an electronic version is sent to the local clinic with the discharge summary. The letter is 5. Patient admission process: identification of Aboriginal and/or Torres Strait Islander ethnicity and local clinic. The question will be asked either at triage or upon admission to the ward, by the ward or emergency clerk. Adherence is measured via audit of discharge summary to check First Nations identification and local clinic contact 6. SMS follow-up reminder system for parent: The automated text will be sent once only at 4-weeks following the date of discharge. The text will remind the parent to go to their local primary care clinic/doctor for review of their child's lungs following their recent admission to hospital for an acute chest infection. Adherence is measured through the number of SMS reminders sent through the system. 7. Discharge process: discharge summary with all relevant information for HCP to provide appropriate follow-up care. Electronic discharge system complete with auto-populated sections to improve process. Adherence is measured through audit of discharge summary compliance with required information 8. Local champions within hospital and primary care system identified and mobilised to improve uptake of systems changes and provide audit and feedback to staff. One or two local champions will be identified per relevant department involved in caring for First Nations children hospitalised with acute chest infections (e.g. department of paediatrics - one doctor, paediatric ward- one nurse, one clerk; physiotherapist - one physiotherapist, emergency - one clerk,). In primary care clinics one clinician champion will be recruited per clinic. Champions will be recruited during the focus group sessions by invitation from the clinical lead at each site. The champions will provide feedback of audited discharge summaries, identification of ethnicity and clinic details and metrics of online module completions within the department at monthly departmental meetings during the intervention stage of the project (approximately 9 months). The feedback is expected to take no more than 5-minutes and will be collated for the local champion by the local research leader. Adherence is measured through recording and reporting the number of champions and interactions recorded at each site. Timeline: The intervention components 1 and 2 commence prior to the implementation period to ensure appropriate tailoring for each site. This period will take about 12-months. Once the intervention commences, core components 3-8 occur simultaneously. Note the first SMS reminder will be sent 1-month following discharge of the first patient, and continue for all subsequent patients. Please note there are three groups in the study. Historical controls do not receive any intervention. The second control group are the "health information only controls". This group is recruited prospectively, when the study commences. This group receive lung health information via the researcher as part of the informed consent process. However, no hospital implementation of the "strategy" has commenced yet, as each site is in the process of determining barriers and facilitators to implementing the "strategy" will be for that site. The stakeholder engagement and appointment of a First Nations lead and adaption of the implementation for each site occurs during this period.