An Initiative to Reduce Routine Viral Diagnostic Testing in Pediatric Patients Admitted with Bronchiolitis

Area of Science:

• Pediatrics
• Infectious Diseases
• Quality Improvement

Background:

• Bronchiolitis, a common viral lower respiratory tract infection in children, contributes to significant pediatric morbidity and mortality.
• Current guidelines do not recommend routine viral diagnostic testing (VDT) for bronchiolitis.
• VDT rates for children admitted with bronchiolitis from the pediatric emergency department (PED) were notably high (63%).

Purpose of the Study:

• To implement a quality improvement project to decrease the utilization of routine VDT in pediatric patients with bronchiolitis.
• To identify key drivers contributing to the overuse of VDT.
• To assess the impact of interventions on VDT rates and associated costs.

Main Methods:

• Interventions included staff education on VDT costs and appropriate use, and implementation of a simplified cohorting policy.
• These interventions were deployed across the PED and inpatient units.
• The project focused on reducing VDT for non-ICU patients admitted from the PED with bronchiolitis.

Main Results:

• VDT use for bronchiolitis admissions from the PED decreased from 63% to 12% between January and April 2017.
• VDT rates for patients seen in the PED also dropped significantly, from 53% to 14%.
• Observed a reduction in VDT for asthma exacerbations (24% to 0%) and documented annual cost savings of approximately $8,584.

Conclusions:

• Simple, low-cost interventions like education and guideline refinement can significantly reduce VDT rates for pediatric bronchiolitis.
• The project demonstrated successful implementation of evidence-based practices to optimize diagnostic testing.
• Future efforts will focus on reducing routine VDT for ICU admissions and outpatient discharges for bronchiolitis.