Inpatient Bronchiolitis Guideline Implementation and Resource Utilization abstract BACKGROUND: Provider-dependent practice variation in children hospitalized with bronchiolitis is not uncommon. Clinical practice guidelines (CPGs) can streamline practice and reduce utilization however, CPG implementation is complex.
METHODS:A multidisciplinary team developed and implemented CPGs for management of bronchiolitis for children ,2 years old. Children with comorbidities, ICU admissions, and outside hospital transfers were excluded. Implementation involved teamwork and collaboration, provider education, online access to CPGs, order sets, data sharing, and monthly team meetings. Resource utilization was defined as use of chest x-rays (CXRs), antibiotics, steroids, and more than 2 doses of inhaled bronchodilator use. Outcome metrics included length of stay (LOS) and readmission rate. Bronchiolitis season was defined as September to April. Data were collected for 2 seasons post implementation.
RESULTS:The number CPG-eligible patients in the pre-and 2 postimplementation periods were similar (1244, preimplementation; 1159, postimplementation season 1; 1283 postimplementation season 2). CXRs decreased from 59.7% to 45.1% (P , .0001) in season 1 to 39% (P , .0001) in season 2. Bronchodilator use decreased from 27% to 20% (P , .01) in season 1 to 14% (P , .002) in season 2. Steroid use significantly reduced from 19% to 11% (P , .01). Antibiotic use did not change significantly (P = .16). LOS decreased from 2.3 to 1.8 days (P , .0001) in season 1 and 1.9 days (P , .05) in season 2. All-cause 7-day readmission rate did not change (P = .45).CONCLUSIONS: Bronchiolitis CPG implementation resulted in reduced use of CXRs, bronchodilators, steroids, and LOS without affecting 7-day all-cause readmissions. Pediatrics 2014;133:e730-e737 Bronchiolitis is a common cause of pediatric hospitalization. Variation in the use of tests and treatments for management of bronchiolitis exists, some of which may contribute to increased health care costs that are estimated to be $545 million annual total direct expenditure nationally. 1 In 2006, the American Academy of Pediatrics published a national clinical practice guideline (CPG) for management of children with bronchiolitis. 2 The CPG does not recommend routine tests and treatments, emphasizing a diagnosis of bronchiolitis based on history and physical examination, and supportive management. Nevertheless, nationally, there is a wide variation in use of tests and treatments in the management of bronchiolitis. [2][3][4] CPGs can be a powerful resource to reduce variation and help providers deliver disease-specific best practice. 5,6 Therefore, many national organizations support development of CPGs. [7][8][9] Integrating a CPG into practice requires changes in physician behaviors and remains a significant challenge. 10 Studies suggest that locally developed CPGs affect patient outcomes more than those developed nationally. 11 At Children' s Medical Center (CMC) Dallas, we noted variation in practice ...
