Using multifaceted education to improve management in acute viral bronchiolitis

Murch, H; Oakley, J; Pierrepoint, Marcus; Powell, Colin

doi:10.1136/archdischild-2014-307353

Cited by 23 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One other study conducted in the United Kingdom showed improved adherence to evidence-based CPGs with the implementation of an educational initiative. 8 Our study further provides evidence that educational interventions can improve targeted outcomes.…”

Section: Discussionsupporting

confidence: 52%

Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Genies

Kim

Pyclik

et al. 2017

Clin Pediatr (Phila)

View full text Add to dashboard Cite

Bronchiolitis is the leading cause of infant hospitalizations in the United States. Despite clinical practice guidelines discouraging the utilization of non–evidence-based therapies, there continues to be wide variation in care and resource utilization. A pre-post physician focused educational intervention was conducted with the aims to reduce the use of non–evidence-based medical therapies, including bronchodilators, among patients admitted for bronchiolitis. Among patients meeting inclusion criteria (pre: n = 45; post: n = 47), bronchodilator use decreased by 50% (P < .001). Antibiotic use increased by 9% (P < .02), although results remained within published acceptable utilization rates of less than 19%. There were no statistical differences in chest X-ray, respiratory viral panel, and steroid use. There were no differences in number of pediatric intensive care unit transfers, 30-day readmission rates, and mean length of stay. The findings demonstrate that a physician-focused educational intervention highlighting American Academy of Pediatrics clinical practice guidelines resulted in reduced utilization of bronchodilators.

show abstract

Section: Discussionsupporting

confidence: 52%

Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Genies

Kim

Pyclik

et al. 2017

Clin Pediatr (Phila)

View full text Add to dashboard Cite

show abstract

“…A recent study conducted in Wales using multifaceted education (developed by the study authors) to reduce investigations (CXR, naso-pharyngeal aspirate, bloods, blood gas and urine) in infants with bronchiolitis, reported a 21% decrease in their use nationally. Directly approaching clinicians for feedback to improve the bundle, as well as increasing involvement with the multi-disciplinary team (doctors and nurses) was recommended [45]. Additionally, Mittal et al reports a reduction in CXR, bronchodilator, glucocorticoid and antibiotic use with the introduction of a clinical practice guideline and multi-faceted education in the United States (designed by a multi-disciplinary team from key stakeholders of a Bronchiolitis Task Force) [46].…”

Section: Discussionmentioning

confidence: 99%

Understanding factors that contribute to variations in bronchiolitis management in acute care settings: a qualitative study in Australia and New Zealand using the Theoretical Domains Framework

et al. 2020

View full text Add to dashboard Cite

Background: Bronchiolitis is the most common reason for infants under one year of age to be hospitalised. Despite management being well defined with high quality evidence of no efficacy for salbutamol, adrenaline, glucocorticoids, antibiotics or chest x-rays, substantial variation in practice occurs. Understanding factors that influence practice variation is vital in order to tailor knowledge translation interventions to improve practice. This study explores factors influencing the uptake of five evidence-based guideline recommendations using the Theoretical Domains Framework. Methods: Semi-structured interviews were undertaken with clinicians in emergency departments and paediatric inpatient areas across Australia and New Zealand exploring current practice, and factors that influence this, based on the Theoretical Domains Framework. Interview transcripts were coded using thematic content analysis.

show abstract

“…A study conducted by Ralston et al to assess a collaborative multicentre strategy19 found a significant decrease in the use of bronchodilators and corticosteroids after the dissemination of the AAP guidelines and education through interactive webinars. Similarly, multifaceted educational bundles, such as the one described by Murch et al ,21 can significantly improve adherence to guidelines. However, there is little knowledge about the use of pharmacotherapy and improvement initiatives for the management of bronchiolitis at the PC level.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Using multifaceted education to improve management in acute viral bronchiolitis

Abstract: This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales.

Cited by 23 publications

References 20 publications

Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study

Understanding factors that contribute to variations in bronchiolitis management in acute care settings: a qualitative study in Australia and New Zealand using the Theoretical Domains Framework

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

Contact Info

Product

Resources

About