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Barriers to Minimizing Respiratory Viral Testing in Bronchiolitis: Physician Perceptions on Testing Practices
Maria Z Huang1, Kyung E Rhee2, Lauren Gist3
1Divisions of Pediatric Hospital Medicine, mzhuang@rchsd.org.
Hospital Pediatrics
|January 17, 2019
Summary
Pediatric providers often avoid respiratory viral testing (RVT) for bronchiolitis, viewing it as unnecessary for medical decisions. However, factors like external direction and a desire for reassurance can lead to its use.
Area of Science:
- Pediatric infectious diseases
- Clinical decision-making
Background:
- Bronchiolitis is a common pediatric respiratory illness.
- Respiratory viral testing (RVT) practices in bronchiolitis vary among clinicians.
Purpose of the Study:
- To evaluate pediatric providers' perspectives on viral testing.
- To identify barriers to reducing RVT in bronchiolitis cases.
Main Methods:
- A single-center, cross-sectional study.
- Six focus group discussions with pediatric providers.
- Thematic analysis of transcribed discussions.
Main Results:
- Providers reported not typically ordering RVT for healthy bronchiolitis patients.
- Key reasons for not ordering RVT included lack of impact on medical decisions and use for trainee education.
- RVT was more likely to be ordered when requested by another clinician, for reassurance, or due to perceived knowledge gaps.
Conclusions:
- Pediatric provider decision-making for RVT is influenced by various internal and external factors.
- Interventions addressing these factors may reduce unnecessary RVT in bronchiolitis.
- Strategies to minimize RVT could be applicable to other patient populations.
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