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Variations in bronchiolitis management between five New Zealand hospitals: can we do better?
A M Vogel1, D R Lennon, J E Harding
1Department of Paediatrics, South Auckland Clinical School, University of Auckland, Starship Children's Hospital, Auckland, New Zealand. alvogel@middlemore.co.nz
Journal of Paediatrics and Child Health
|January 25, 2003
Summary
Management of bronchiolitis in New Zealand infants varied significantly between hospitals. Interventions like oxygen, fluids, antibiotics, and chest X-rays were used more frequently than in previous studies, indicating potential for improved, cost-effective care.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Public Health
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Current management practices for bronchiolitis can vary significantly.
- Optimizing treatment is crucial for patient outcomes and healthcare costs.
Purpose of the Study:
- To assess current bronchiolitis management in five major New Zealand hospitals.
- To identify variations in treatment protocols among these institutions.
- To pinpoint areas for potential improvement in bronchiolitis care.
Main Methods:
- Retrospective review of hospital records for infants under one year admitted with bronchiolitis in 1998.
- Data collected from five large New Zealand hospitals with pediatric services.
- Analysis of management strategies including oxygen, fluid support, antibiotics, bronchodilators, and diagnostic tests.
Main Results:
- 409 infants admitted; 8% were preterm, 53% under 6 months.
- High rates of intervention: 59% oxygen, 65% received fluids (NG/IV), 34% antibiotics, 42% bronchodilators, 60% chest X-ray.
- Significant inter-hospital variations in management practices were observed.
- Intervention rates were substantially higher than a 1986-1988 study (65% vs 25%).
Conclusions:
- Opportunities exist to rationalize bronchiolitis management in New Zealand.
- Reducing unnecessary chest radiographs, antibiotics, and bronchodilators could lead to cost savings.
- Standardizing care protocols may improve efficiency and potentially outcomes.
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