Related Experiment Video
Updated: Jul 24, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Impact of an Intervention to Reduce Bronchodilator Use in Bronchiolitis - A Time Series Analysis
Joanna Lawrence1,2,3,4, Harriet Hiscock2,3, Alice Voskoboynik4
1Electronic Medical Record Team, Royal Children's Hospital, Melbourne, Australia.
Insights
A multifaceted intervention significantly reduced bronchodilator prescriptions for infants with bronchiolitis. This approach, including electronic medical record alerts, effectively curbed low-value care in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Clinical Quality Improvement
Background:
- International guidelines advise against bronchodilator use in bronchiolitis.
- Reducing low-value care in pediatrics remains an evolving challenge.
- The effectiveness of interventions for reducing low-value care needs further investigation.
Purpose of the Study:
- To evaluate a multifaceted intervention's impact on bronchodilator prescription rates in pediatric bronchiolitis cases.
- To assess the effectiveness of combining education, audit-feedback, and electronic medical record (EMR) alerts.
Main Methods:
- Utilized interrupted time series analysis on 76 months of EMR data from a pediatric teaching hospital's emergency department.
- Included infants aged 1-12 months diagnosed with bronchiolitis.
- The intervention, implemented in February 2019, comprised education, clinician audit-feedback, and an EMR alert.
Main Results:
- Analyzed data from 9576 infants diagnosed with bronchiolitis.
- Bronchodilator prescription rates decreased from 6.9% to 3.2% post-intervention.
- The intervention was statistically associated with a significant reduction in prescribing rates (P = .037).
Conclusions:
- A multifaceted intervention, particularly incorporating EMR alerts, can effectively reduce low-value bronchodilator prescribing in bronchiolitis.
- This strategy accelerates the decline of unnecessary medical care.
- The intervention supports sustainable changes in clinical practice for pediatric respiratory infections.
Background And Objectives:
International guidelines recommend against the use of bronchodilators in bronchiolitis. Despite attempts to address low value care practices in pediatrics, the literature is still evolving regarding which interventions are most effective in low value care reduction. We aim to assess the impact of a multifaceted intervention on rates of bronchodilator prescription in bronchiolitis.
Methods:
With electronic medical record (EMR) data over a 76- month period, we evaluated changes in bronchodilator prescription among infants aged 1 to 12 months diagnosed with bronchiolitis, using interrupted time series analysis, controlling for preintervention prescribing trends. The setting was the emergency department of a large teaching pediatric hospital. The intervention included education, clinician audit-feedback, and an EMR alert, implemented February 2019. The main outcome measure was rate of bronchodilator prescription per month.
Results:
There were 9576 infants, aged 1 to 12 months, diagnosed in the emergency department with bronchiolitis over the study period. Bronchodilator ordering reduced from 6.9% to 3.2% after the intervention. Once underlying trends were accounted for, the multifaceted intervention was associated with a reduction in the rate of prescribing (inter-rater reliability 0.98, 95% confidence interval 0.96 to 0.99, P = .037).
Conclusions:
We found that the multifaceted intervention, including an EMR alert, may be an effective method of reducing low value care prescribing in bronchiolitis, accelerating the reduction of unnecessary care and supporting sustainable change.
More Related Videos
05:31Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
09:58A Reversible, Non-invasive Method for Airway Resistance Measurements and Bronchoalveolar Lavage Fluid Sampling in Mice
Published on: April 13, 2010
Related Concept Videos
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:23Inhaled Medications