A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis

Shawn Ralston, Matthew D. Garber, Elizabeth Rice-Conboy, Grant M. Mussman, Kristin A. Shadman, Susan C. Walley, Elizabeth Nichols

Research output: Contribution to journalArticle

Abstract

Background and Objective: Evidence-based gGuidelines for acute viral bronchiolitis recommend primarily supportive care, but unnecessary care remains well documented. Published quality improvement work has been accomplished inchildren's hospitals, but little broad dissemination has been reported outside of those settings. We sought to use a voluntary collaborative strategy to disseminatebest practices to reduce overuse of unnecessary care in children hospitalized for bronchiolitis in community settings. METHODS: This project was aquality improvement collaborative consisting of monthly interactive webinars with online data collection and feedback. Data were collected by chart review for 2 bronchiolitis seasons, defined as January, February, and March of 2013 and 2014. Patients aged <24 months hospitalized for bronchiolitis and without chronic illness, prematurity, or intensive care use were included. Results were analyzed using run charting, analysis of means, and nonparametric statistics. Results: There were 21 participating hospitals contributing a total of 1869 chart reviews to the project, 995 preintervention and 874 postintervention. Mean use of any bronchodilator declined by 29% (P =.03) and doses per patient decreased 45% (P <.01). Mean use of any steroids declined by 68% (P <.01), and doses per patient decreased 35% (P =.04). Chest radiography use declined by 44% (P =.05). Length of stay decreased 5 hours (P <.01), and readmissions remained unchanged. Conclusions: A voluntary collaborative was effective in reducing unnecessary care among a cohort of primarily community hospitals. Such a strategy may be generalizable to the settings where the majority of children are hospitalized in the United States.

Original languageEnglish (US)
Article numbere20150851
JournalPediatrics
Volume137
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Guideline Adherence
Unnecessary Procedures
Bronchiolitis
Pediatric Hospitals
Quality Improvement
Cooperative Behavior
Inpatients
Hospitalization
Hospitalized Child
Viral Bronchiolitis
Bronchodilator Agents
Community Hospital
Critical Care
Child Care
Nonparametric Statistics
Radiography
Length of Stay
Chronic Disease
Thorax
Steroids

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Ralston, S., Garber, M. D., Rice-Conboy, E., Mussman, G. M., Shadman, K. A., Walley, S. C., & Nichols, E. (2016). A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis. Pediatrics, 137(1), [e20150851]. https://doi.org/10.1542/peds.2015-0851

A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis. / Ralston, Shawn; Garber, Matthew D.; Rice-Conboy, Elizabeth; Mussman, Grant M.; Shadman, Kristin A.; Walley, Susan C.; Nichols, Elizabeth.

In: Pediatrics, Vol. 137, No. 1, e20150851, 01.01.2016.

Research output: Contribution to journalArticle

Ralston, S, Garber, MD, Rice-Conboy, E, Mussman, GM, Shadman, KA, Walley, SC & Nichols, E 2016, 'A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis', Pediatrics, vol. 137, no. 1, e20150851. https://doi.org/10.1542/peds.2015-0851
Ralston S, Garber MD, Rice-Conboy E, Mussman GM, Shadman KA, Walley SC et al. A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis. Pediatrics. 2016 Jan 1;137(1). e20150851. https://doi.org/10.1542/peds.2015-0851
Ralston, Shawn ; Garber, Matthew D. ; Rice-Conboy, Elizabeth ; Mussman, Grant M. ; Shadman, Kristin A. ; Walley, Susan C. ; Nichols, Elizabeth. / A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis. In: Pediatrics. 2016 ; Vol. 137, No. 1.
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