Table 1 Intervention description using the TIDieR guidelines for intervention reporting [26]

Training day (core component)

Investigators were invited to attend a training day where the intervention was showcased and key behaviour change techniques to be communicated to their trainees were highlighted

Senior clinicians were provided with all the paper-based intervention materials in a bound form for reference. Materials were also provided in an electronic form for all study team members

Key behaviour changes and materials were delivered by the study team and a representative from The Encephalitis Society also shared their patient journey

Delivered once per site at the start of the intervention

Took place in a central location with additional local meetings as required

Feedback from this session led to the modification of intervention materials to make them more applicable to each hospital

Action planning meeting (core component)

Following training, investigators were asked to plan an implementation of intervention components

A form was provided which provided key topics to discuss and plan around

Each local PI ran the meeting

Training preceded this meeting, and it was requested that at least one was held prior to any educational sessions

Within each hospital with core team members

Sites could meet as frequently as required

Audit and feedback newsletter (core component)

An audit and feedback newsletter was produced with personalised data alongside an action planning element

Electronic and laminated copies were provided which contained personalised audit data, a link to the guidelines to promote action planning, and space to add local clinical leaders to add credibility

The study team provided the materials with the local clinical leaders distributing to their team

This was delivered electronically and in hard copy for distribution and display alongside all other intervention components

This will be displayed within the hospital nearby the other components such as the poster or the guideline algorithm

This newsletter was personalised to contain audit data from each hospital. It also contained a comparison with other anonymised hospitals, as well as to the recommended time frames for care

Lumbar puncture box (core component)

A refillable box with all the key equipment to perform a lumbar puncture was provided with sample collection information which could be locally modified as required

A box containing equipment for the procedure alongside a sheet detailing sample collection was provided. Adult and paediatric boxes were available due to different sample collection requirements

The study team supplied 2–6 boxes to each hospital as required

Boxes were delivered at the start of the intervention period and on an ad hoc basis

Boxes were placed in relevant locations as designated by each hospital

The sample sheet could be locally modified by each site to accommodate sample procedures

Pre-made lectures with integrated behaviour change techniques were produced for the following uses: - A session focused upon the diagnostic lumbar puncture - A session focused upon the management of suspected encephalitis - A session for nurses on how to help with lumbar punctures

Pre-made lectures were provided alongside a range of other multimedia resources including: - A DVD showing nurses how to assist with the procedure - Two clinical vignettes - The Encephalitis Society YouTube channel - TS’ ‘Big Brain’ event on YouTube

The study team provided the resources for the local team to deliver as required

Sites were able to choose the frequency of delivery, with a recommended minimum of one per 6 months

All training will take place within the hospital and will be delivered by clinicians

These materials can be locally modified with a core set of slides so preserve behaviour change integrity. Furthermore, these are all modified for use in both an adult and paediatric setting and can be used as often as required by the local team

Educational survey (optional component)

An online multiple choice educational survey was developed with tailored questions for doctors and nurses. This online tool can be accessed at any time and all participants can download a certificate of completion

An online multiple choice educational survey was developed. A certificate of completion was awarded with additional checklists and action planning tools

Site PIs were able to circulate this online link to all junior doctors

The trainee would only complete the survey once with a certificate of completion

This could take place during a teaching session or during private study

Two surveys were available with questions tailored for doctors and nursing staff

ClickClinica [27] (optional component)

An app containing all current guidelines was developed. This has been promoted within our package both within the education and also within the personalised invitation letter as a useful tool

An app has been developed for use with iPhones whereby all guidelines are available in one place

This app was promoted through local clinical leaders

The link to download the app was within the educational sessions and contained within the direct mail letter

Guidelines can be checked and downloaded on the ward or within private study

None available for this component

Encephalitis Society leaflets and video (optional component)

The Encephalitis Society YouTube channel was included as a resource which could be incorporated into the education. Furthermore, patient leaflets will be disseminated to the investigators during the study

Printed materials for the patients and healthcare professionals were provided. These materials were also featured within the educational sessions

These were provided by The Encephalitis Society, forwarded by the study team and disseminated by the local clinical leaders

These were provided at the start and middle of the intervention period with reinforcement from the educational sessions

The YouTube videos could be used during the educational session or within a private study session as part of a critical reflection

None available for this component

A quality improvement cycle (plan, do, study, act (PDSA)) was developed and included: - A summary page with the key guideline recommendations - A short list of key check box items to monitor current practice - An excel sheet which pre-plots the progress

Printed packs were provided alongside an electronic excel sheet with pre-plotting graphs to enable feedback

The study team provided all materials and these were locally disseminated by the clinical leader

Electronic materials were provided at the start of the study with printed materials provided within the 6-month update. Local clinical leaders were encouraged to ask a junior doctor to assess current management and feedback performance data

Within the ward where the local PI is based as part of a post-take ward round. The quality improvement graphs should also be displayed within this area

Junior doctors are able to feedback the areas of compliance they feel are most relevant to the department

Basis of modifiable care pathway (optional component)

The front sheet from the quality improvement cycle could also be modified to form the basis of a care pathway for suspected encephalitis patients. This will be locally driven and implemented at each site

A traffic light coloured sheet with the critical patient management items was provided as a basis to modify

The study team provided the resource and it was then adapted by the local clinical team

This was provided once at the start of the intervention

Local clinical leaders will modify and display in key areas of the hospital

This sheet was to be locally adapted if taken up

Algorithm (optional component)

The algorithm contained within the guidelines was reproduced with two additional features; a QR code which links directly to the guidelines and a box that contained details for local senior support

A laminated guideline algorithm was provided with a QR code to link to the original guidelines and a space for local modification with the additional of a local contact

The study team provided the materials, and they were disseminated throughout the hospital by the local clinical team

A minimum of five were provided to each site at the start and a further five were also provided after 6 months

These will be placed in key areas of the hospital as denoted by the local clinical leader

These are available in adult and paediatric forms and can be locally modified by the addition of a suitable contact if clinical decision support is required

Posters (optional component)

Posters with key symptoms and relevant QR codes were designed and graphics covered paediatric, adults and geriatrics

Three posters were provided to cover a variety of ages alongside the key clinical symptoms. A QR code to the guideline was also incorporated

The study team provided the materials, and they were disseminated throughout the hospital by the local clinical team

A minimum of five were provided to each site at the start, and a further five were also provided after 6 months

These will be placed in key areas of the hospital as denoted by the local clinical leader

None available for this component

Stickers (optional component)

Small stickers with ‘Think brain infection’ were produced for application to blood sample bottles

‘Think brain infection’ stickers were provided to raise awareness during the sample taking procedure

The local study team provided these on an ad hoc basis and the local clinical leaders affixed these to sample bottles as required

These were provided on an ad hoc basis with supplements sent within the 6-month update

These will be added to all relevant bottles as denoted by the study team

None available for this component

Invitation letter (optional component)

A template invitation letter from the consultant inviting the junior doctor to attend each of the education session was developed for local modification. Details of the lumbar puncture box and ClickClinica were also included

An electronic letter was made for each of the educational sessions

The study team provided the basis of a letter which will then be modified and sent by the consultant

This invitation letter can be sent prior to all educational sessions

Letters will be sent directly to the junior doctors to personally invite them to attend the educational session

The basis of the letter was provided for local modification