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Pediatrics. 2018 Jun;141(6). pii: e20170485. doi: 10.1542/peds.2017-0485. Epub 2018 May 11.

Interventions to Reduce Over-Utilized Tests and Treatments in Bronchiolitis.

Author information

1
Children's Hospital Colorado, Aurora, Colorado; amy.tyler@childrenscolorado.org.
2
Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado; and.
3
Children's Hospital Colorado, Aurora, Colorado.
4
Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado.

Abstract

OBJECTIVES:

The American Academy of Pediatrics published bronchiolitis clinical practice guidelines in 2014 recommending against the routine use of bronchodilators, chest radiographs, or respiratory viral testing in children with a clinical diagnosis of bronchiolitis. Our aim in this project was to align care with the American Academy of Pediatrics clinical practice guidelines by decreasing the overuse of these interventions.

METHODS:

This study included patients who were admitted to a non-ICU setting with a primary or secondary diagnosis of bronchiolitis. The team used a multidisciplinary kickoff event to understand the problem and develop interventions, including sharing provider-specific data and asking providers to sign a pledge to reduce use. We used a novel, real-time data dashboard to collect and analyze data.

RESULTS:

Special cause variation on control charts indicated improvement for all outcomes for inpatients during the intervention season. Pre- and postanalyses in which we compared baseline to intervention values for all admitted patients and patients who were discharged from the emergency department or urgent care revealed a significant reduction in the ordering of chest radiographs (from 22.7% to 13.6%; P ≤ .001), respiratory viral testing (from 12.5% to 9.8%; P = .001), and bronchodilators (from 17.5% to 10.3%; P = .001) without changes in balancing measures (eg, hospital readmission within 7 days [1.7% (preanalysis) and 1.0% (postanalysis); P = .21]) for bronchiolitis.

CONCLUSIONS:

This multidisciplinary improvement initiative resulted in a significant reduction in use for bronchiolitis care at our institution. Our approach, which included a novel, real-time data dashboard and interventions such as individual providers pledging to reduce use, may have the potential to reduce overuse in other settings and diseases.

PMID:
29752289
DOI:
10.1542/peds.2017-0485
[Indexed for MEDLINE]
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