Pediatric Bronchiolitis Quality Improvement
| Status: | Recruiting |
|---|---|
| Conditions: | Bronchitis |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any - 2 |
| Updated: | 6/23/2018 |
| Start Date: | May 31, 2018 |
| End Date: | December 31, 2019 |
| Contact: | Michelle Hamline, MD, PhD |
| Email: | mhamline@ucdavis.edu |
| Phone: | 916-734-5387 |
Pediatric Bronchiolitis Quality Improvement to Reduce Unnecessary Use of Diagnostic Testing and Treatment
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.
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.
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.
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.
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
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