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Published on: January 17, 2011
Sustaining the implementation of an evidence-based guideline for bronchiolitis
P H Perlstein1, U R Kotagal, P J Schoettker
1Division of Health Policy and Clinical Effectiveness, Children's Hospital Medical Center, Cincinnati, OH, USA. Uma.Kotagal@UC.edu.
Insights
Implementing an evidence-based guideline for infant bronchiolitis care significantly reduced hospital admissions and length of stay. This clinical practice guideline also decreased resource utilization and associated costs, demonstrating sustained benefits.
Area of Science:
- Pediatrics
- Clinical Practice Guidelines
- Respiratory Illness
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Clinical practice guidelines aim to standardize and improve care for conditions like bronchiolitis.
- Evaluating the long-term impact of guideline implementation is crucial for healthcare quality improvement.
Purpose of the Study:
- To assess the impact of an evidence-based clinical practice guideline for infant bronchiolitis over a three-year period.
- To evaluate changes in patient admissions, length of stay, and resource utilization following guideline implementation.
- To determine the sustained effectiveness of the guideline in a major pediatric care facility.
Main Methods:
- A before-and-after study design was employed.
- Data were collected from infants (≤1 year) hospitalized with bronchiolitis.
- Patient data from 1993-1996 (pre-guideline) were compared with data from 1997-1999 (post-guideline implementation).
Main Results:
- Hospital admissions for bronchiolitis decreased by 30%, and mean length of stay reduced by 17%.
- Use of diagnostic tests like nasopharyngeal washings for respiratory syncytial virus and chest x-rays decreased significantly.
- There were substantial reductions in respiratory therapies, including beta(2)-agonist inhalations, and associated costs.
Conclusions:
- The evidence-based clinical practice guideline for infant bronchiolitis care was successfully implemented and sustained.
- The guideline led to significant improvements in resource utilization and cost-effectiveness.
- This study demonstrates the long-term benefits of adhering to evidence-based practices in pediatric care.
Objective:
To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis.
Design:
Before and after study.
Setting:
Children's Hospital Medical Center, Cincinnati, Ohio.
Patients:
Infants 1 year or younger admitted to the hospital with a first-time episode of typical bronchiolitis.
Intervention:
The guideline was implemented January 15, 1997. Data on all patients discharged from the hospital with bronchiolitis, from January 15 through March 27, in 1997, 1998, and 1999, were stratified by year and compared with data on similar patients discharged from the hospital in the same periods in the years 1993 through 1996.
Main Outcome Measures:
Patient volumes, length of stay for admissions, and use of specific laboratory and therapeutic resources ancillary to bed occupancy.
Results:
After implementation of the guideline, admissions decreased 30% and mean length of stay decreased 17% (P<.001). Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients (P<.001); 14% fewer chest x-ray films were ordered (P<.001). There were significant reductions in the use of all respiratory therapies, with a 17% decrease in the use of at least 1 beta(2)-agonist inhalation therapy (P<.001). In addition, 28% fewer repeated inhalations were administered (P<.001); mean costs for all resources ancillary to bed occupancy fell 41% (P<.001); and mean costs for respiratory care services fell 72% (P<.001).
Conclusions:
An evidence-based clinical practice guideline for the care of patients encountered in major pediatric care facility has been successfully sustained beyond the initial year of its introduction to practitioners in southwest Ohio.
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