Initiatives to reduce treatments in bronchiolitis in the emergency department and primary care

Abstract

We performed a quality improvement initiative to reduce unnecessary treatments for acute bronchiolitis (AB) in primary care (PC) and the referral paediatric emergency department (ED). The quality improvement initiative involved two seasons: 2016–2017 (preintervention) and 2017–2018 (postintervention). We distributed an evidence-based protocol, informative posters and badges with the slogan ‘Bronchiolitis, less is more’. We also held interactive sessions, and paediatricians received weekly reports on bronchodilator prescription. The main outcome was the percentage of infants prescribed salbutamol. Secondary outcomes were epinephrine, antibiotic and corticosteroid prescription rates. Control measures were ED visit and hospitalisation rates, triage level, length of stay, intensive care admission and unscheduled returns with admission. We included 1878 ED and 1192 PC visits of which 855 (44.5%) and 534 (44.7%) occurred in the postintervention period, respectively. In the ED, salbutamol and epinephrine prescription rates fell from 13.8% (95% CI 11.8% to 16%) to 9.1% (95% CI 7.3% to 11.2%) (p<0.01) and 10.4% (95% CI 8.6% to 12.4%) to 9% (95% CI 7.2% to 11.1%) (n.s.), respectively. In PC, salbutamol, corticosteroid and antibiotic prescription rates fell from 38.3% (95% CI 34.6% to 42.0%) to 15.9% (95% CI 12.9% to 19.5%) (p<0.01), 12.9% (95% CI 10.5% to 15.7%) to 3.6% (95% CI 2.2% to 5.7%) (p<0.01) and 29.6% (95% CI 26.2% to 33.2%) to 9.5% (95% CI 7.2% to 12.5%) (p<0.01), respectively. No significant variations were noted in control measures. We safely decreased the use of unnecessary treatments for AB. Collaboration between PC and ED appears to be an important factor for success.

Treatment for acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Oslo, Norway

“…The reduction in the use of nebulised beta-2-agonists is supported by new guidelines and research, 2 9 22–25 and is a focus across the world. 24 25 Antibiotic treatment is not recommended for acute bronchiolitis, 9 26 27 and overuse is a known problem. 28–30 Our results showed a very low use of antibiotics, consistently below 5%, compared with other countries, where rates in the range of 3.5%–11.1% are reported.…”

UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants

“…In addition, the creation and diffusion of parents' educational materials (information leaflet) on the evidencebased management of bronchiolitis can inform parents who often expect and demand medications for their sick infants and avoid the "doctor-shopping" for treating bronchiolitis. In parallel, the diffusion of information leaflets about environmental prophylaxis of RSV and other viruses can be helpful in protecting infants from these infections [36,37].…”

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

“…Современные руководства, основываясь на доказательствах в представленном Кокрановском обзоре [91], не рекомендуют рутинное применение антибиотиков при ОБ [1,[7][8][9][10][11]. Однако исследования свидетельствуют, что нес мотря на кампании по активному сокращению назначений антибактериальных препаратов у больных ОБ до 9,5 % вне ОРИТ [92] и до 19-70 % больных ОБ в ОРИТ продолжают получать антибиотики [6,12]. Риск вторичной бактериальной пневмонии возрастает у де тей, госпитализированных в ОРИТ, и может быть связан с присоединением нозокомиальной инфекции [93].…”