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Decreasing unnecessary utilization in acute bronchiolitis care: results from the value in inpatient pediatrics

Shawn Ralston1, Matthew Garber, Steve Narang

  • 1Department of Pediatrics, Division of Inpatient Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA. Shawn.L.Ralston@hitchcock.org

Journal of Hospital Medicine
|October 11, 2012
PubMed

Insights

A quality improvement collaborative reduced unnecessary treatments for pediatric bronchiolitis. Benchmarking led to significant decreases in bronchodilator and chest physiotherapy use in hospitalized children.

Area of Science:

  • Pediatric hospital medicine
  • Quality improvement science
  • Evidence-based practice

Background:

  • Acute viral bronchiolitis is a leading cause of pediatric hospital admissions.
  • Non-evidence-based therapies and testing are frequently used despite available evidence.
  • Quality improvement efforts are needed to optimize bronchiolitis care.

Purpose of the Study:

  • To decrease the use of unnecessary therapies in hospitalized pediatric patients with bronchiolitis.
  • To implement evidence-based practices across a network of diverse clinical sites.

Main Methods:

  • A voluntary quality improvement collaborative of pediatric hospitalists was formed.
  • Benchmarking of bronchodilator, steroid, chest radiography, chest physiotherapy, and viral testing use was conducted.
  • Shared resources included protocols, scores, order sets, and bibliographies to establish norms for decreasing utilization.

Main Results:

  • Data from 11,568 hospitalizations across 17 centers were analyzed.
  • Bronchodilator utilization decreased by 46% overall, with a 3.4 dose per patient absolute decrease.
  • A 12 percentage point reduction in overall exposure to any dose of bronchodilator was observed.
  • Chest physiotherapy usage also declined significantly; however, no significant changes were noted for steroids, chest radiography, or viral testing.

Conclusions:

  • Benchmarking within a collaborative pediatric hospitalist network effectively reduced bronchodilator and chest physiotherapy use in bronchiolitis care.
  • This approach facilitated the adoption of evidence-based practices in a multi-center setting.
Abstract

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