The 2006 American Academy of Pediatrics (AAP) management guidelines for bronchiolitis recommends reducing the misuse and overuse of short acting beta agonist bronchodilator therapy for pediatric patients with bronchiolitis. Our institution has participated in the Value in Inpatient Pediatrics (VIP) since 2008, which is a multicenter network of pediatric facilities that share data about the management of common pediatric inpatient problems including bronchiolitis. Our institution currently has an order set and protocol that complies with the AAP recommendations; however despite this we have a relatively high use of bronchodilator therapy (80% compared to 67% at other institutions) for inpatient pediatric patients with bronchiolitis. Our bronchodilator doses per encounter have also been higher in comparison to other institutions (8.2 doses/encounter compared to 5.9). We hypothesize by the introduction of a bronchiolitis clinical score and associated protocol will be able to decrease our bronchodilator use for patients admitted with bronchiolitis.
A quality improvement team including nursing staff, respiratory therapists and residents was formed to institute a validated bronchiolitis score (see table 1) and protocol. The scoring protocol was disseminated to the residents, respiratory therapists and nurses and implemented in February 2011. Data collection was done retrospectively on admitted patients less than 2 years old with a primary diagnosis of bronchiolitis and included: age of the patient, use of bronchodilators including the number of doses throughout the admission, use of the bronchiolitis score, variable direct costs and length of stay. Data analysis was done comparing prescore implementation data (2009 and 2010) to data of patients admitted after February 2011.
Preliminary results from Feb through June 2011 are presented in Table 2.
Instituting a bronchiolitis score and protocol decreases the overall use of bronchodilators in the treatment of inpatient pediatric patients with bronchiolitis without increasing the length of stay.
Table 1Bronchiolitis Clinical Score
|Respiratory Rate||Normal 02 months > 60, >2 months >50||0 1|
|Accessory Muscles||Normal Suprasternal/Subcostal/IC retractions Neck or abdominal muscle use||0 1 2|
|Air exchange||Normal Localized decrease Multi areas decreased||0 1 2|
|Wheezes||End expiratory/none Entire expiration Entire expiration and inspiration||0 1 2|
Table 2PreScore (2010) compared to PostScore (2011) Data
|Length of stay||Bronchodilator doses per encounter|
|N = number of encounters||Mean (SD)||Median (Range)||%age of patient receiving bronchodilators||Mean (SD)||Median (Range)|
|2010 Data||132||3.05 (1.57)||3.0 (110)||110 (83%)||8.24 (9.79)||4.5 (048)|
|2/20116/2011 Data||40||2.73 (1.30)||2.5 (16)||31 (79%)||3.25 (3.55)||1.5 (029)|
|pvalue||N/A||0.24 (ttest)||0.33 (Wilcoxon test)||0.48 (Fisher’s exact test)||0.0023 (ttest)||0.0010 (Wilcoxon test)|
To cite this abstract:Marzo C, Len K, Bergert L, Shea W. Decreased Use of Bronchodilators with Implementation of Bronchiolitis Clinical Score. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97649. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/decreased-use-of-bronchodilators-with-implementation-of-bronchiolitis-clinical-score/. Accessed November 20, 2019.