Decreasing Racemic Epinephrine for Bronchiolitis in an Academic Children's Hospital

Area of Science:

• Pediatric respiratory medicine
• Healthcare quality improvement
• Clinical intervention studies

Background:

• Bronchiolitis is a primary cause of hospitalization for children in the U.S.
• The American Academy of Pediatrics advises against routine bronchodilator use for bronchiolitis.
• Racemic epinephrine was frequently administered for bronchiolitis at Le Bonheur Children's Hospital, contrary to guidelines.

Purpose of the Study:

• To decrease the use of racemic epinephrine for bronchiolitis by 50% within an 8-month period.
• To implement and evaluate a quality improvement initiative targeting medication use in pediatric bronchiolitis.
• To align clinical practice with evidence-based recommendations for bronchiolitis management.

Main Methods:

• A multidisciplinary team utilized the Institute for Healthcare Improvement's Model for Improvement.
• Plan-do-study-act cycles were employed to guide the intervention.
• Focused educational strategies and direct feedback were provided to healthcare professionals involved in pediatric care.
• Statistical process control charts monitored racemic epinephrine and albuterol use, as well as length of stay.

Main Results:

• Racemic epinephrine administration decreased from an average of 26% to 5% among hospitalized bronchiolitis patients.
• Albuterol use also declined from 48% to 34% during the intervention period.
• No significant changes in the length of hospital stay were observed.

Conclusions:

• A multidisciplinary approach combined with targeted education can effectively reduce the use of racemic epinephrine in pediatric bronchiolitis cases.
• This strategy supports adherence to clinical guidelines and may improve the quality of care for infants and children with bronchiolitis.
• Quality improvement initiatives are crucial for optimizing medication use in common pediatric respiratory conditions.