A quality improvement intervention to reduce emergency department radiography for bronchiolitis

Abstract

This key intervention was successful in reinforcing the AAP guidelines, promoting greater cost-effectiveness, reducing radiation exposure, and saving valuable time and resources for the ED staff and the hospital.

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

“…2 A cohort study performed in Israel 8 points out that the thoracic X-ray is used for different respiratory emergencies, especially bronchiolitis, even if there is no recommendation for its use, according to the American Academy of Pediatrics (AAP). 8 A similar orientation was identified in the North-American analysis, 9 which does not advise the use of thoracic X-ray to treat acute exacerbation of asthma. 9 The analysis conducted in the Republic of Korea 10 stated there are many physicians using the X-ray in the screening of non-specific abdominal symptoms due to difficulties in diagnosis.…”

“…14 5th category -instruments used to reduce the exposure to ionizing agents in pediatric emergency patients Several instruments are used to guide health professionals as to the use of imaging examinations, in order to reduce the unnecessary exposure to ionizing agents in pediatric UE patients. 1,2,[7][8][9][10][11][12] The Alvarado Score is used for abdominal CT. 2 For head CT, the following instruments were reported: Pediatric Emergency Care Applied Research Network (PECARN), 1,2,7,12 National Emergency X-Radiography Utilization Study (NEXUS), 1,7 Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) 1 and Canadian Assessment of Tomography for Childhood Head Injury (CATCH). 1,7 The last two, however, were considered little reliable for clinical use due to their low sensitivity.…”

“…9 Among the analyzed articles, some implemented effective proposals to reduce the use of imaging examinations. In the cohort study, 8 an intervention that aims at limiting the use of thoracic X-ray to diagnose bronchiolitis and assess if pediatric UEs follow the current guidelines was implemented. Before intervention, the level of radiography was 44%, and then decreased to 36.6%.…”

“…The authors suggested that similar interventions should be implemented in other pediatric UEs. 8 A study 11 analyzed the implementation of a policy whose purpose was to reduce the use of CT in patients with suspicion of peritonsillar abscess, recommending that professionals in the UEs request the evaluation of otolaryngologists before requiring imaging examinations in pediatric patients with unspecific physical examination. The efficacy of this policy was proven by observing a 13% reduction in the use of CT in the analyzed populations.…”

Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period

“…Moreover, there is no quick fix as no type of implementation has shown to be the most effective. 24 Nonetheless, more active approaches to guideline implementation such as educational meetings and outreach, 25 and audit and feedback 26 may give approximately 20% reduction passive approaches such as postal dissemination where the effect range from none 27,28 up to 10% difference between intervention and control group. 29…”