Reducing Albuterol Use in Children With Bronchiolitis

Area of Science:

• Pediatrics
• Clinical Practice Guidelines
• Health Services Research

Background:

• Bronchiolitis is a common pediatric respiratory infection.
• The American Academy of Pediatrics released guidelines in 2014 advising against bronchodilator use for bronchiolitis.
• Previous bronchodilator (albuterol) use rates were high in emergency and inpatient settings.

Purpose of the Study:

• To reduce the proportion of patients with bronchiolitis receiving albuterol in emergency and inpatient settings.
• To align clinical practice with updated pediatric guidelines for bronchiolitis management.

Main Methods:

• A multidisciplinary team identified drivers of albuterol use.
• Clinical pathways and order sets were redesigned to discourage routine albuterol.
• Education was provided to clinicians, and albuterol use was monitored weekly.
• Admission rate, length of stay, and revisit rates were tracked as balancing measures.

Main Results:

• Emergency department albuterol use decreased from 43% to 20%.
• Inpatient albuterol use decreased from 18% to 11%.
• These reductions met statistical thresholds for special cause variation and were sustained throughout the season.

Conclusions:

• Redesigning clinical pathways and order sets effectively reduced albuterol use for bronchiolitis.
• The intervention was successful in a large children's hospital setting.
• Key outcome measures, including admission rates and length of stay, remained unchanged.