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Table 1 Description of intervention and usual care groups according to the Template for Intervention Description and Replication (TIDieR) [37]

From: The IMPROVE-GAP Trial aiming to improve evidence-based management of community-acquired pneumonia: study protocol for a stepped-wedge randomised controlled trial

TIDieR criterion Intervention Usual care
Item 1. Brief name: Provide the name or a phrase that describes the intervention Community-acquired pneumonia service Usual inpatient hospital care
Item 2. Why: Describe any rationale, theory or goal of the elements essential to the intervention A large RCT and meta-analysis [12, 14] demonstrated faster clinical recovery and shorter length of stay with adjunct corticosteroids without significant adverse events. Routine adjunctive corticosteroid is now widely supported though as yet not consistently deployed.
Early switch to oral antibiotics guided by a set of well-defined basic clinical and laboratory criteria [17] also reduces length of stay. Recently, a RCT incorporating both measures demonstrated a length of stay reduction of 2 days compared with standard care [18].
Early mobilisation safely and effectively reduces length of stay when applied appropriately [16].
Routine screening of medical inpatients for malnutrition and appropriate targeted nutrition therapy can reduce unplanned readmissions [19]
Usual inpatient hospital care will be delivered as per underlying usual care rationale, theories and goals of community-acquired pneumonia management
Item 3. What (materials): Describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers Patient information materials will not apply as a waiver of consent is sought.
Intervention providers will be given an intervention algorithm tool to prompt safe, systematic and appropriate initiation of the four evidence-based interventions
Nil additional to usual care
Item 4. What (procedures): Describe each of the procedures, activities or processes used in the intervention, including any enabling or support activities The community-acquired pneumonia service will apply a set of protocols to ensure rigorous application of interventions each with proven efficacy including:
1.Routine prescription of 50 mg prednisolone for 7 days (following checklist exclusion of those with contraindications) [12, 14]
2.Constrained parenteral antibiotic duration (using pre-defined ‘stopping rules’) [17, 18]
3.Physiotherapy-led early (< 24 h) mobilisation [16]
4.Routine malnutrition screening and implementation of an appropriate nutrition therapy intervention as indicated [19, 41]
During the non-interventional control periods (as determined by the stepped-wedge rollout schedule) patients with community-acquired pneumonia will receive conventional care by the usual treating general internal medicine team: currently, 43% receive corticosteroids, 63% physiotherapy (median time to initiation 2 days), 65% guideline-compliant antibiotics [4].
No parenteral antibiotic stopping rules are in place (median 3 days).
72% of inpatients at Western Health currently receive routine malnutrition screening
Item 5. Who provided: For each category of intervention provider (for example, psychologist, nursing assistant), describe their expertise, background and any specific training given Relevant members of the general internal medicine multidisciplinary team (doctors, nurses, physiotherapists and dietitians) will deliver the community-acquired pneumonia service intervention.
Clinicians treating patients in the intervention arm of the study will be given an education package outlining current evidence-based practice guidelines and the treatment protocols to be applied. Intervention arm clinicians will also have access to decision-support algorithms to promote consistent application of the protocols
The general internal medicine multidisciplinary team will deliver usual care
Item 6. How: Describe the modes of delivery (such as face to face or by some other mechanism, such as internet or telephone) of the intervention and whether it was provided individually or in a group Face-to-face individual intervention Face-to-face individual intervention
Item 7. Where: Describe the types of location where the intervention occurred, including any necessary infrastructure or relevant features Acute hospital wards; patients under the care of the general internal medicine unit Acute hospital wards; patients under the care of the general internal medicine unit
Item 8. When and how much: Describe the number of times the intervention was delivered and over what period of time, including the number of sessions, their schedule, and their duration, intensity or dose Daily during acute hospital admission During acute hospital admission at the discretion of treating medical, allied health and nursing clinicians
Item 9. Tailoring: If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how The four best-practice interventions will aim to be delivered to all patients meeting the inclusion criteria, except in the case of specific contraindication to an intervention as outlined in this protocol. The protocol for each of the interventions also outlines circumstances where treatment can be individualised.
General internal medicine consultants may vary their provision of care given difficulties in delivering rigid protocols in a healthcare setting and their perspective of the importance of delivering individualised medicine; however, non-adherence and the reasons for it will be measured and reported for any deviations in the protocols
At the discretion of the treating medical team and allied health clinicians
Item 10. Modifications: If the intervention was modified during the course of the study, describe the changes (what, why, when, how) Not applicable in protocol Not applicable in protocol
Item 11. How well (planned): If intervention adherence or fidelity was assessed, describe how and by whom; if any strategies were used to maintain or improve fidelity, describe them Patient proportions receiving:
i) Corticosteroids
ii) Pre-defined intravenous antibiotic stopping rules
iii) Early mobilisation
iv) Malnutrition Screening Tool application and appropriate nutrition therapy
Aim for relevant proportions to exceed 70% for interventions (i) and (ii), and 85% for (iii) and (iv). Protocol adherence rates will be available to the project coordinator throughout the study, allowing high protocol non-compliance rates to be addressed in a timely fashion.
Fidelity will be maximised by the daily interaction with community-acquired pneumonia team which promotes and monitors protocol adherence
Patient proportions receiving:
i) Corticosteroids
ii) Pre-defined intravenous antibiotic stopping rules
iii) Early mobilisation
iv) Malnutrition Screening Tool application and appropriate nutrition therapy.
Anticipate existing data on proportions to be maintained
Item 12: How well (actual): If intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned Not applicable in protocol Not applicable in protocol