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Updated: Jul 13, 2026
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Quality improvement project to decrease unnecessary investigations in infants with bronchiolitis in Cork University
Lizeri Jansen1,2, Gideon-Phil Meyer3,2, Glenn Curtin3
1Emergency Department, Cork University Hospital, Cork, Ireland lizerijansen@gmail.com.
Insights
Implementing an evidence-based protocol significantly reduced unnecessary chest X-rays and lab tests for infants with bronchiolitis. This improves infant care and optimizes healthcare resource use during peak seasons.
Area of Science:
- Pediatrics
- Emergency Medicine
- Public Health
Background:
- Bronchiolitis is a frequent cause of emergency department (ED) visits for infants.
- Existing guidelines advise against routine radiological and laboratory tests for bronchiolitis.
- A preintervention audit revealed unnecessary investigations were common in infants under 12 months with bronchiolitis.
Purpose of the Study:
- To decrease unnecessary investigations in infants diagnosed with bronchiolitis.
- To enhance patient care quality by adhering to evidence-based guidelines.
- To optimize resource utilization in the emergency department during peak winter seasons.
Main Methods:
- A preintervention audit assessed investigation rates (chest X-ray, laboratory tests) and hospital length of stay (LOS) for infants with bronchiolitis.
- A multimodal intervention was introduced, including a clinical flowchart and regular performance feedback.
- A postintervention audit evaluated the impact of the intervention on investigation rates, LOS, and patient re-representation rates.
Main Results:
- The mean weekly chest X-ray rate decreased by 57% (25% to 11%, p<0.05).
- The mean weekly laboratory investigation rate improved by 56% (29% to 13%, p<0.05).
- Average weekly patient re-representation rates and hospital LOS showed no significant changes.
Conclusions:
- An evidence-based protocol effectively reduced unnecessary investigations for infants with bronchiolitis.
- The intervention improved diagnostic and management capabilities, enhancing patient care quality.
- Reduced unnecessary testing contributes to decreased healthcare costs and efficient resource allocation.
Background:
Bronchiolitis is a common reason for infants to present to the emergency department (ED). Clear evidence-based guidelines exist that recommend against routine radiological and laboratory investigations in this cohort. Despite this, preintervention audit showed that children below 12 months of age with bronchiolitis in the ED during November 2018-January 2019 were receiving unnecessary investigations. Our aim was to improve patient care by decreasing unnecessary investigations in bronchiolitis infants.
Methods:
Baseline assessment comprised a preintervention audit of children less than 12 months of age with a diagnosis of bronchiolitis that presented to ED during November 2018-January 2019. The outcome measure was average weekly hospital length of stay (LOS), process measures were average weekly chest X-ray (CXR) and laboratory investigation rate. The balancing measure was the average weekly representation rate.
Intervention:
A multimodal intervention was implemented comprising a locally agreed flowchart enhanced by regular feedback on performance using run charts and in-person sessions.
Results:
A postintervention audit of November 2019-January 2020 was undertaken. There was a 57% reduction in the mean average weekly CXR rate (from 25% to 11%, p value 0.009974 significant at p<0.05); there was an improvement by 56% in the mean average weekly laboratory investigation rate (from 29% to 13%, p value 0.005475, significant at p<0.05) in the preintervention and postintervention periods, respectively. The mean average weekly representations remained at 4% preintervention and postintervention (p value 0.737). There was no significant difference in hospital LOS (from 25.3 hours to 20.7 hours, p value 0.270549).
Conclusion:
An evidence-based protocol improved physicians' ability in diagnosing and managing infants with bronchiolitis. This led to a reduction in unnecessary and potential harmful investigations, thereby improving patient quality of care. This improvement will contribute to decreased healthcare cost and appropriate use of resources during the high-pressured winter period.
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