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institutional health service improvement projects as a key enabler to their success. CONCLUSIONS The study provides support that an intervention underpinned by challenge driven learning and team coaching can improve a range of health service delivery outcome variables.BACKGROUND The benefit of intravenous sodium bicarbonate administration in patients with severe metabolic acidosis remains controversial, partly due to lack of double-blind trials. From a practical viewpoint, such blinding requires testing of the stability of sodium bicarb