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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Evaluation of an evidence-based guideline for bronchiolitis
P H Perlstein1, U R Kotagal, C Bolling
1Division of Health Policy, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. paul.perlstein@uc.edu
Insights
Implementing an evidence-based clinical practice guideline for infant bronchiolitis significantly reduced hospital admissions, length of stay, and resource utilization. This pediatric guideline improved care efficiency and lowered costs in its first year.
Area of Science:
- Pediatrics
- Clinical Practice Guidelines
- Health Services Research
Background:
- Bronchiolitis is a common respiratory infection in infants, frequently leading to hospitalization.
- Clinical practice guidelines aim to standardize and improve the quality of care for conditions like bronchiolitis.
- Previous management strategies for infant bronchiolitis varied, potentially impacting resource use and patient outcomes.
Purpose of the Study:
- To evaluate the impact of implementing an evidence-based clinical practice guideline for inpatient infant bronchiolitis care.
- To assess changes in hospital admissions, length of stay, and resource utilization following guideline implementation.
- To determine the effect of the guideline on the costs associated with inpatient bronchiolitis management.
Main Methods:
- A multidisciplinary team developed a guideline for infants under 1 year with typical bronchiolitis.
- Data from January 15, 1997, through March 27, 1997, were compared to data from the same periods in 1993-1996.
- Hospital charts and clinical/financial databases were used to extract data on length of stay (LOS) and resource use.
Main Results:
- Admissions decreased by 29%, and mean LOS decreased by 17% post-guideline implementation.
- Use of diagnostic tests (nasopharyngeal washings, chest radiographs) and respiratory therapies (beta-agonist inhalations) significantly decreased.
- Mean costs for ancillary services dropped by 37%, and respiratory care costs decreased by 77%.
Conclusions:
- The evidence-based clinical practice guideline for managing infant bronchiolitis was highly effective in modifying care.
- Implementation led to substantial reductions in resource utilization and associated costs.
- The study demonstrates the successful application of evidence-based medicine in pediatric inpatient care for bronchiolitis.
Objective:
To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio.
Methodology:
A multidisciplinary team generated the guideline for infants < or = 1 year old who were admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and financial databases. They included LOS and use and costs of resources ancillary to bed occupancy.
Results:
After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 beta-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%.
Conclusions:
An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.
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