Bronchiolitis
Conditions
Keywords
Bronchiolitis, Children, Hospital
Brief summary
Bronchiolitis is a respiratory illness characterized by acute inflammation of the airways, typically caused by a virus. By definition, it impacts children between 2 months and 2 years of age and is the most common cause of hospitalization among infants in the first year of life (American Academy of Pediatrics). Children with this illness may exhibit respiratory distress, as well as symptoms of viral respiratory illness, such as sneezing, nasal congestion, and cough. Often, hospitalization is required for respiratory distress and to support hydration needs. Evidence based guidelines for the treatment of acute viral bronchiolitis primarily involve supportive care, which most often includes supplemental oxygen, hydration, and suctioning of secretions. However, in practice, bronchiolitis care is highly variable, often involving therapies such as inhaled bronchodilators, systemic corticosteroids, inhaled hypertonic saline, continuous pulse oximetry, chest physiotherapy, antibacterial medications, and use of intravenous fluids, all of which have been shown to be unnecessary and costly. Unnecessary care remains although multiple published quality improvement studies centered on acute bronchiolitis have proven successful. Quality improvement interventions have shown reduced use of unnecessary treatments and reduced resource allocation. Therefore, the investigators will conduct a quality improvement process to improve adherence to bronchiolitis treatment guidelines for children with bronchiolitis treated at University of California Davis Children's Hospital.
Detailed description
A multidisciplinary team, involving pediatric hospitalists, pediatric emergency physicians, residents, medical students, nurses and nurse managers, and respiratory therapists will be assembled. The investigators will participate in a value stream mapping process, to map out the current pediatric bronchiolitis care process and identify areas for improvement in efficiency and effectiveness. The investigators will then begin the iterative process of implementing improvements to the bronchiolitis care process. Interventions will be evidence-based and designed to improve compliance with bronchiolitis care guidelines, as set forth by the American Academy of Pediatrics. Examples of possible interventions may include creation of a bronchiolitis admission order set, implementation of an evidence-based bronchiolitis clinical pathway, and/or institution of standardized bronchiolitis discharge criteria. Interventions will be implemented in a stepwise fashion, utilizing successive plan-do-study-act cycles, with a minimum 2 month period between interventions to monitor outcomes. The investigators will track utilization of diagnostic testing and treatments within our intervention group, as compared to historical controls who also meet inclusion criteria.
Interventions
OTHERBronchiolitis quality improvement
Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.
Sponsors
University of California, Davis
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
The investigators will conduct a quality improvement process for all children diagnosed with bronchiolitis at our hospital who meet inclusion criteria. Outcomes for these patients will be compared with retrospective controls.
Eligibility
Sex/Gender
ALL
Age
1 Days to 2 Years
Healthy volunteers
No
Inclusion criteria
* Children less than 2 years of age admitted to UC Davis Children's Hospital with any diagnosis of bronchiolitis
Exclusion criteria
* Children or adults greater than 2 years of age * Children born at less than 35 weeks gestational age * Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intravenous fluid utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received intravenous fluid |
| Supplemental oxygen utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received supplemental oxygen |
| Continuous pulse oximetry utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received continuous pulse oximetry |
| Chest x-ray utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received a chest x-ray |
| Antibiotic utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received antibiotics |
| Bronchodilator utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received bronchodilators |
| Steroid utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received steroids |
| Hypertonic saline utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received nebulized hypertonic saline. |
| Chest physiotherapy utilization | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received chest physiotherapy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Emergency room revisit rate | Within 30 days following the index hospitalization discharge date | Same hospital emergency room revisit rate for patients with a diagnosis of bronchiolitis |
| Bronchiolitis specific discharge instructions | Through study completion, an average of 19 months | Percentage of patients meeting inclusion criteria who received bronchiolitis specific handout containing care instructions on discharge |
| Timely completion of discharge summary | Within 48 hours of discharge from the index hospitalization | Percentage of patients meeting inclusion criteria who had a discharge summary completed |
| Length of stay index | Through study completion, an average of 19 months | A ratio of observed to expected length of stay for patients admitted with bronchiolitis, as compared to national standards |
| Timely routing of discharge summary | Within 48 hours of discharge from the index hospitalization | Percentage of patients meeting inclusion criteria who had a discharge summary routed to their primary care provider |
| CC capture rate | Through study completion, an average of 19 months | The capture rate for comorbid conditions within our charting for patients diagnosed with bronchiolitis |
| MCC capture rate | Through study completion, an average of 19 months | The capture rate for major comorbid conditions within our charting for patients diagnosed with bronchiolitis |
| Readmission rate | Within 30 days following the index hospitalization discharge date | Same hospital readmission rate for patients with a diagnosis of bronchiolitis |
Countries
United States
Outcome results
None listed