Pediatric Bronchiolitis Quality Improvement
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Retrospective Controls A retrospective control group of patients with a diagnosis of bronchiolitis and meeting inclusion criteria will be used as a comparison group. These patients received usual care for bronchiolitis at our institution. |
|
| Experimental: Quality Improvement All patients diagnosed with bronchiolitis and meeting inclusion criteria will undergo the intervention of a bronchiolitis quality improvement process to improve bronchiolitis care quality at our institution. |
Other: Bronchiolitis quality improvement
Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.
|
Outcome Measures
Primary Outcome Measures
- 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
- Intravenous fluid utilization [Through study completion, an average of 19 months]
Percentage of patients meeting inclusion criteria who received intravenous fluid
- Continuous pulse oximetry utilization [Through study completion, an average of 19 months]
Percentage of patients meeting inclusion criteria who received continuous pulse oximetry
- Supplemental oxygen utilization [Through study completion, an average of 19 months]
Percentage of patients meeting inclusion criteria who received supplemental oxygen
Secondary Outcome Measures
- 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
- Readmission rate [Within 30 days following the index hospitalization discharge date]
Same hospital readmission rate for patients with a diagnosis of bronchiolitis
- 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
- 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
Eligibility Criteria
Criteria
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
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Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | UC David Medical Center | Sacramento | California | United States | 95817 |
Sponsors and Collaborators
- University of California, Davis
Investigators
- Principal Investigator: Michelle Hamline, MD, PhD, University of California, Davis
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 1219188