Table 2 TIDieR checklist

 1.

Provide the name or a phrase that describes the intervention.

Evidence Rounds

 2.

Describe any rationale, theory, or goal of the elements essential to the intervention.

This information is provided in the Background section of this paper.

 3.

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. Provide information on where the materials can be accessed (e.g. online appendix, URL).

Physical materials:

• laptop, projector, cables, presenter remote, printer, paper, ink cartridges

• audio recording equipment, extension lead

Informational materials:

• Evidence Rounds website: www.evidencerounds.com. See Table 1 for more details.

• Posters promoting educational session (see Additional file 2), participant recruitment posters, signage

• participant information leaflets and consent forms for focus groups and interviews (reported in part 2 [26])

A budget contributed towards facilitator costs, catering services, printing, website development and hosting services

 4.

Procedures: Describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities.

1. Selection of clinical question or topic – HCPs invited to submit and when necessary, gain consensus on suggestions

2. Recruitment of staff to present - 3 HCPs presented evidence at each session. Staff either volunteered or members of the implementation team contacted specific staff to invite them to present based on their area of expertise

3. Search for evidence and screening - One of the researchers (AC) performed focused literature searches and initial sifting of obviously irrelevant results. The HCPs who were presenting the session in question, each screened the remaining results to narrow it down to the resources which they judged to be the best available evidence or key official guidance on the topic. Each resource was considered in terms of relevance, level of evidence and currency.

4. Presentation preparation

• each presenter was assigned records to present according to their preferences of study design and level of experience

• presenters used appropriate critical appraisal tools to identify strengths and limitations

• presenters decided whether to briefly present local audit data to ground the research and make it more meaningful to attendees

• decision about whether topic warranted invitation to HCPs from outside of departments to attend when perceived as advantageous

• provision of ongoing enablement and support to presenters e.g. critical appraisal help, extraction and visualisation of data etc.

• presenters had the opportunity to plan the final part of their presentation focusing on:

o briefly summarising the key findings of the evidence

o exploring the relevance and applicability of evidence to local context

o identifying potential barriers & facilitators to implementing the evidence

5. Evidence Rounds group sessions

Each monthly session had the following structure:

• overview of official guidance and summarisation and critical appraisal of key evidence

• discussion of relevance and applicability of evidence to local practice

• if applicable, identification of potential barriers and facilitators to implementation of evidence

• if applicable, discussion and decision making regarding actions to be taken in light of the evidence and assignment of actions to responsible persons

 5.

For each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given.

Presenters and other members of the implementation team were qualified physicians, nurses or midwives. The initiative was led by a knowledge translation specialist who has experience of collaborating with HCPs to promote evidence-informed practice in women and children’s divisions at hospitals and had the following training:

• Postgraduate Diploma in Research Methods in Health Sciences (University of Warwick, UK)

• Knowledge Translation Professional Certificate (St. Michael’s Hospital Toronto and the University of Toronto, Canada)

 6.

Describe the modes of delivery (e.g. 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.

The modes of delivery are described in Table 1.

 7.

Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features.

Each educational session was delivered in a classroom located adjacent to wards for the convenience of staff who could be bleeped or called away at any moment. After the second session, we discussed the possibility of changing to a larger venue but decided against this as the location worked well and the capacity it held was viewed as ideal for promoting discussion, had adequate seating capacity and audio-visual technology to display presentation slides.

Interviews and focus groups took place in the maternity boardroom, maternity classroom or in HCP offices within the department. A few preparatory meetings for presenters took place in the hospital canteen or a nearby café to align with staff lunchtimes.

 8.

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.

Six educational sessions were delivered over nine months. We took a flexible approach to scheduling by avoided exam times, holidays, training or other educational sessions and meetings in order to maximise attendance figures. As requested by staff, Evidence Rounds group sessions were scheduled during lunchtimes. Each session lasted approximately 1 h because the implementation team identified this as a realistic duration of attendance for most HCPs. Immediately after each educational presentation, a facilitated discussion forum took place which lasted for up to 30 min. They were timetabled on Fridays at lunchtimes (excluding the final session which took place on a Wednesday). Before each session email reminders were sent to potential attendees by HCP members of the implementation team and in some cases they delivered in-person reminders on the hospital wards.

 9.

If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when, and how.

Evidence Rounds was adapted throughout its duration in response to the needs and expressed preferences of the audience and the local context, as was planned. All feedback from attendees was considered and acted upon if appropriate and possible, at the earliest opportunity so that subsequent delivery was improved.

 10.

If the intervention was modified during the course of the study, describe the changes (what, why, when, and how).

The initiative was modified throughout the course of the study in accordance with feedback from users and observations. For example:

• specific patient cases were not a formal part of the presentation

• local audit data was collected retrospectively and reported at 3 of the 6 sessions

• a brief “Quick guide for presenters” was uploaded to the website in response to frequently asked questions (see Additional file 1)

• social network accounts on Facebook, Twitter and LinkedIn were abandoned due to lack of interest. Additional effort was put into posters, website information, email correspondence and face-to-face interactions as preferred by HCPs

• the schedule of group sessions was altered to accommodate staff holidays, exams and other educational events to optimise attendance. Therefore, the initiative was delivered over 9 rather than the original plan of 6 months

• certificates of participation and attendance were introduced in response to a request from staff after the second session

• in the final group session, one of the presenters was not working as a HCP at the hospital. He is the author of 2 papers that were going to be discussed so he was identified as the best person to present the findings. He is an author on this paper (DD)

• during one of the group sessions, an attendee requested the circulation of a topic suggestion sheet so that individuals who for whatever reason did not want to make suggestions in front of their colleagues, could contribute.

 11.

Planned: If intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them.

We did not assess adherence or fidelity. However, core components of the initiative were identified before the first session and adhered to throughout the duration. Those components were:

1. Clinical question or topic -focused approach to deciding on the content of educational program

2. Literature searches to be conducted by experienced professional

3. Aim to include the best available evidence

4. Monthly group sessions

5. Discussion forum after presentations to discuss possibility of and identify resulting actions

6. Multidisciplinary and interprofessional target audience

12.^a

Actual: If intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned.

N/A