Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines

Sprecher, Eli; Chi, Grace; Ozonoff, Al; Cox, Joanne E.; Patel, N.; Conroy, Kathleen

doi:10.1542/peds.2017-4156

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…After education in our initiative, CDT entry increased and peaked at ∼60%; however, declines were observed within 6 months. In particular, although past research suggests that public reporting of individual performance might be an effective method to motivate provider behavior change, 30,31 this was not observed in our study. Instead, we observed that public auditing and reporting of attending-provider performance was associated with essentially static levels of CDT use.…”

Section: Discussioncontrasting

confidence: 91%

Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Sklansky¹,

Butteris²,

Shadman³

et al. 2019

Pediatrics

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BACKGROUND AND OBJECTIVES: Hospital discharge requires multidisciplinary coordination. Insufficient coordination impacts patient flow, resource use, and postdischarge outcomes. Our objectives were to (1) implement a prospective, multidisciplinary discharge timing designation in the electronic health record (EHR) and (2) evaluate its association with discharge timing. METHODS: This quality-improvement study evaluated the implementation of confirmed discharge time (CDT), an EHR designation representing specific discharge timing developed jointly by a patient's family and the health care team. CDT was intended to support task management and coordination of multidisciplinary discharge processes and could be entered and viewed by all team members. Four plan-do-study-act improvement phases were studied: (1) baseline, (2) provider education, (3) provider feedback, and (4) EHR modification. Statistical process control charts tracked CDT use and the proportion of discharges before noon. Length of stay was used as a balancing measure. RESULTS: During the study period from April 2013 through March 2017, 20 133 pediatric discharges occurred, with similar demographics observed throughout all phases. Mean CDT use increased from 0% to 62%, with special cause variations being detected after the provider education and EHR modification phases. Over the course of the study, the proportion of discharges before noon increased by 6.2 percentage points, from 19.9% to 26.1%, whereas length of stay decreased from 47 (interquartile range: 25-95) to 43 (interquartile range: 24-88) hours (both P , .001). CONCLUSIONS: The implementation of a prospective, multidisciplinary EHR discharge time designation was associated with more before-noon discharges. Next steps include replicating results in other settings and determining populations that are most responsive to discharge coordination efforts.

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Section: Discussioncontrasting

confidence: 91%

Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Sklansky¹,

Butteris²,

Shadman³

et al. 2019

Pediatrics

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“…The application of clinical practice guidelines aims to improve the quality of healthcare and has direct benefits for patients and healthcare costs by reducing the probability of adverse effects, the damage resulting from additional tests, and the healthcare expenditure [9]. Hospital protocols are necessary, although it is also important to raise awareness about the benefits of supportive measures and the disadvantages of unnecessary pharmacological treatments through clinical sessions and other educational interventions [28,33]. Evaluation of modifications in clinical practice and patient outcomes after implementation of the protocol also acts as a key positive reinforcement for clinicians.…”

Section: Discussionmentioning

confidence: 99%

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

et al. 2021

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Background Bronchiolitis caused by the respiratory syncytial virus (RSV) is the main reason for hospitalization in infants. Supportive care is the mainstay of treatment, and tests are restricted to a few indications. During 2015, our hospital bronchiolitis protocol (2015 HBP) was updated according to the latest practice guidelines. Objective The objective of this study was to assess implementation of the 2015 HBP and the clinical outcome of children aged ≤ 24 months with RSV bronchiolitis admitted to a pediatric ward. Methods We compared the use of treatments and tests, hospital length of stay (LOS), and oxygen requirements before imple-

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“…There are few reports in the English literature showing a successful effort to decrease albuterol use, and most of these studies only showed an absolute reduction of albuterol use by 7% to 16% or a reduction occurring in the outpatient setting. 3,8,[11][12][13][14] Using a novel strategy of order set modifications, we were able to achieve absolute levels of bronchodilator use lower than the lowest rate of 33% reported in any previous inpatient work. Our order set intervention provides a more specific strategy for hospitals to adapt than a previous multicenter project.…”

Section: Discussionmentioning

confidence: 99%

Reducing Albuterol Use in Children With Bronchiolitis

et al. 2020

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OBJECTIVES:In 2014, the American Academy of Pediatrics published bronchiolitis guidelines recommending against the use of bronchodilators. For the winter of 2015 to 2016, we aimed to reduce the proportion of emergency department patients with bronchiolitis receiving albuterol from 43% (previous winter rate) to ,35% and from 18% (previous winter rate) to ,10% in the inpatient setting.METHODS: A team identified key drivers of albuterol use and potential interventions. We implemented changes to our pathway and the associated order set recommending against routine albuterol use and designed education to accompany the pathway changes. We monitored albuterol use through weekly automated data extraction and reported results back to clinicians. We measured admission rate, length of stay, and revisit rate as balancing measures for the intervention. RESULTS:The study period included 3834 emergency department visits and 1119 inpatient hospitalizations. In the emergency department, albuterol use in children with bronchiolitis declined from 43% to 20% and was ,3 SD control limits established in the previous year, meeting statistical thresholds for special cause variation. Inpatient albuterol use decreased from 18% to 11% of patients, also achieving special cause variation and approaching our goal. The changes in both departments were sustained through the entire bronchiolitis season, and admission rate, length of stay, and revisit rates remained unchanged.CONCLUSIONS: Using a multidisciplinary group that redesigned a clinical pathway and order sets for bronchiolitis, we substantially reduced albuterol use at a large children's hospital without impacting other outcome measures.Bronchiolitis is 1 of the most common reasons for hospitalization in young children, accounting for 18% of hospital admissions for children younger than age 1 and $1.73 billion in hospital charges in the United States in 2009. 1 Bronchodilators are commonly used to treat children with bronchiolitis, although research has shown no benefit in respiratory status of inpatients, admission rate, or hospital length of stay. 2,3 In 2014, the American Academy of Pediatrics (AAP) updated their guidelines on bronchiolitis, recommending against treatment with bronchodilators. 3,4 One of the Society of Hospital Medicine's 5 opportunities for increasing value in health care is not using bronchodilators in bronchiolitis. 5 Despite the AAP guideline and meta-analyses recommending against the use of bronchodilators, this practice is common throughout pediatric institutions. 6,7

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Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines

Cited by 14 publications

References 22 publications

Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record

Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

Reducing Albuterol Use in Children With Bronchiolitis

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