Care Variation Among Sites Participating in a National Quality Improvement Initiative for Croup

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Clinical Pathway Analysis

Background:

• Significant variation exists in the clinical management of pediatric croup.
• Acute care settings and hospital types exhibit differences in established croup treatment protocols.

Purpose of the Study:

• To characterize the variability in clinical pathways for treating croup.
• To analyze differences in croup management strategies across various acute care settings and hospital types within a national quality improvement collaborative.

Main Methods:

• A cross-sectional study design was employed.
• Data collection involved site surveys to determine hospital characteristics and independent physician review of existing croup clinical pathways.
• Surveys were distributed through the Pediatric Acute and Critical Care and Quality Network listserv.

Main Results:

• Out of 107 participating sites, 96 completed surveys, with 48 (50.0%) reporting established croup pathways.
• Of the 30 reviewed pathways, 17 were from emergency departments (EDs) and 13 from mixed ED/urgent care (UC) settings.
• Significant variations were observed in recommendations for racemic epinephrine treatments, neck/chest radiography guidance between ED and ED/UC sites, and these differences persisted when stratified by hospital type.

Conclusions:

• Considerable heterogeneity exists in current pediatric croup clinical pathways across different acute care settings.
• The Better Assessment and Response to Croup in Kids (BARCK) quality improvement collaborative presents a crucial opportunity to standardize croup care practices nationwide.