Standardizing the Care of Bronchiolitis

Adcock, Penny M.; Sanders, Carla L.; Marshall, Gary S.

doi:10.1001/archpedi.152.8.739

Cited by 59 publications

(32 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies evaluating the implementation of bronchiolitis CPGs for inpatient management at pediatric centres have found a reduction in the use of beta-agonist therapy, chest x-rays, and viral testing. [10][11][12][13] A recent study comparing children's hospitals with bronchiolitis CPGs to hospitals without CPGs found that the presence of a CPG was not associated with less use of unnecessary medication and investigations. 36 Interestingly, when change in bronchiolitis inpatient management was examined across many of these same pediatric hospitals before and after publication of the AAP bronchiolitis CPG, a significant improvement was seen in the use of chest x-rays, systemic corticosteroids, and bronchodilators over time.…”

Section: Discussionmentioning

confidence: 99%

“…9 Several pediatric centres have demonstrated a reduction in the use of beta-agonist therapy, chest x-rays, and viral testing with implementation of a bronchiolitis clinical practice guideline (CPG). [10][11][12][13] However, most children with bronchiolitis who present to a hospital are treated and discharged from the emergency department (ED). [6][7][8] Many are also managed outside children's hospitals where physicians may be less comfortable with bronchiolitis and less familiar with recent literature regarding bronchiolitis management.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario. Methods: We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season. Results: Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%). Conclusions: Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals. RÉSUMÉObjectif: La bronchiolite est le principal motif d'hospitalisation des enfants en bas âge, mais peu d'études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l'étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario. Méthode: Les auteurs ont procédé à un examen rétrospectif d'une cohorte d'enfants consécutifs, âgés de moins de 12 mois, qui souffraient d'une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d'une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial. Résultats: Sur 543 enfants admissibles à l'étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d'admission à l'hôpital variaient énormément (intervalle interquartile : 0-40,3%). L'utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu'à l'étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des pa...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…The characteristics of the 14 studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38] in this review are described in Table 1, including our qualitative assessment of the categorical type of intervention (described later in further detail): primarily educational (providing voluntary guidelines, presenting conferences); involving significant process change (implementing standardized order sets); and involving significant process change plus the use of a respiratory score. A respiratory score was loosely defined as any multicomponent numerical representation of respiratory effort.…”

Section: Included Studiesmentioning

confidence: 99%

“…Four studies reported decreased charges or costs associated with the intervention, 26,27,30,36 and 1 study reported no change. 25 …”

Section: Harms/balancing Measuresmentioning

confidence: 99%

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

View full text Add to dashboard Cite

BACKGROUND: Bronchiolitis causes nearly 20% of all acute care hospitalizations for young children in the United States. Unnecessary testing and medication for infants with bronchiolitis contribute to cost without improving outcomes. OBJECTIVES:The goal of this study was to systematically review the quality improvement (QI) literature on inpatient bronchiolitis and to propose benchmarks for reducing unnecessary care. METHODS:Assisted by a medical librarian, we searched Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Studies describing any active QI intervention versus usual care in hospitalized children ,2 years of age were included. Data were extracted and confirmed by multiple investigators and pooled by using a random effects model. Benchmarks were calculated by using achievable benchmarks of care methods. RESULTS:Fourteen studies involving .12 000 infants were reviewed. QI interventions resulted in 16 fewer patients exposed to repeated doses of bronchodilators per 100 hospitalized (7 studies) (risk difference: 0.16 [95% confidence interval: 0.11-0.21]) and resulted in 5.3 fewer doses of bronchodilator given per patient (95% confidence interval: 2

show abstract

“…21 However, given that these types of hospitals are serving a disproportionately large share of medically complex and low-SES children, these hospitals should prioritize implementation of interventions shown to improve quality of care for children admitted with respiratory illness. Single-center studies have shown clinical pathways improve antimicrobial use 38 and reduce radiation exposure, video-assisted thoracoscopic surgery procedures, and readmission rates in children admitted for pneumonia 9 ; reduce resource utilization, [39][40][41] LOS, 41 and readmissions 8 in children admitted for bronchiolitis; and increase home asthma management teaching 7 and decrease in LOS 5,42 in children admitted for asthma. Larger, multicenter studies are needed to determine if clinical pathways are an effective means of improving quality of care for respiratory illnesses, and if pathways are found to be effective, policies should incentivize large, urban-teaching hospitals to implement pathways.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Kaiser

Bakel

Okumura

et al. 2015

Hospital Pediatrics

View full text Add to dashboard Cite

A B S T R A C T BACKGROUND AND OBJECTIVES:Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). METHODS:Cross-sectional study of hospitalizations of patients ,18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (.90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). CONCLUSIONS: Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions). RESULTS:

show abstract

Standardizing the Care of Bronchiolitis

Cited by 59 publications

References 17 publications

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations

Contact Info

Product

Resources

About