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Inpatient bronchiolitis guideline implementation and resource utilization
Vineeta Mittal1, Cindy Darnell, Brian Walsh
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; and.
Insights
Implementing clinical practice guidelines (CPGs) for bronchiolitis in children reduced chest x-rays, bronchodilators, steroids, and length of stay (LOS). This initiative successfully streamlined care without impacting 7-day readmission rates.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Healthcare Management
Background:
- Provider-dependent practice variation is common in pediatric bronchiolitis hospitalizations.
- Clinical practice guidelines (CPGs) offer a strategy to standardize care and reduce resource utilization.
- Implementing CPGs presents challenges in healthcare settings.
Purpose of the Study:
- To assess the impact of implementing CPGs for bronchiolitis management in children under 2 years old.
- To evaluate changes in resource utilization and patient outcomes following CPG implementation.
- To determine the effectiveness of a multidisciplinary approach to CPG implementation.
Main Methods:
- A multidisciplinary team developed and implemented CPGs for pediatric bronchiolitis (<2 years old), excluding complex cases.
- Implementation strategies included provider education, online access, order sets, and collaborative meetings.
- Resource utilization (chest x-rays, antibiotics, steroids, bronchodilators) and outcomes (length of stay, readmissions) were tracked for two seasons post-implementation.
Main Results:
- Chest x-ray use decreased significantly post-implementation (59.7% to 39%).
- Inhaled bronchodilator and steroid use also saw significant reductions.
- Length of stay decreased significantly, while antibiotic use and 7-day readmission rates remained unchanged.
Conclusions:
- Implementation of bronchiolitis CPGs effectively reduced the utilization of specific diagnostic tests and treatments.
- CPG implementation led to a significant decrease in length of stay for hospitalized children with bronchiolitis.
- The study demonstrated that CPGs can be implemented successfully to optimize resource use without adversely affecting patient readmission rates.
Background:
Provider-dependent practice variation in children hospitalized with bronchiolitis is not uncommon. Clinical practice guidelines (CPGs) can streamline practice and reduce utilization however, CPG implementation is complex.
Methods:
A multidisciplinary team developed and implemented CPGs for management of bronchiolitis for children <2 years old. Children with comorbidities, ICU admissions, and outside hospital transfers were excluded. Implementation involved teamwork and collaboration, provider education, online access to CPGs, order sets, data sharing, and monthly team meetings. Resource utilization was defined as use of chest x-rays (CXRs), antibiotics, steroids, and more than 2 doses of inhaled bronchodilator use. Outcome metrics included length of stay (LOS) and readmission rate. Bronchiolitis season was defined as September to April. Data were collected for 2 seasons post implementation.
Results:
The number CPG-eligible patients in the pre- and 2 postimplementation periods were similar (1244, preimplementation; 1159, postimplementation season 1; 1283 postimplementation season 2). CXRs decreased from 59.7% to 45.1% (P < .0001) in season 1 to 39% (P < .0001) in season 2. Bronchodilator use decreased from 27% to 20% (P < .01) in season 1 to 14% (P < .002) in season 2. Steroid use significantly reduced from 19% to 11% (P < .01). Antibiotic use did not change significantly (P = .16). LOS decreased from 2.3 to 1.8 days (P < .0001) in season 1 and 1.9 days (P < .05) in season 2. All-cause 7-day readmission rate did not change (P = .45).
Conclusions:
Bronchiolitis CPG implementation resulted in reduced use of CXRs, bronchodilators, steroids, and LOS without affecting 7-day all-cause readmissions.
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