Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care

Grant M. Mussman, Michele Lossius, Faiza Wasif, Jeffrey Bennett, Kristin A. Shadman, Susan C. Walley, Lauren Destino, Elizabeth Nichols, Shawn Ralston

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: There is high variation in the care of acute viral bronchiolitis. We sought to promote collaboration between emergency department (ED) and inpatient (IP) units with the goal of reducing unnecessary testing and treatment. METHODS: Multisite collaborative with improvement teams co-led by ED and IP physicians and a 1-year period of active participation. The intervention consisted of a multicomponent change package, regular webinars, and optional coaching. Data were collected by chart review for December 2014 through March 2015 (baseline) and December 2015 to March 2016 (improvement period). Patients <24 months of age with a primary diagnosis of bronchiolitis and without ICU admission, prematurity, or chronic lung or heart disease were eligible for inclusion. Control charts were used to detect improvement. Achievable benchmarks of care were calculated for each measure. RESULTS: Thirty-five hospitals with 5078 ED patients and 4389 IPs participated. Use of bronchodilators demonstrated special cause for the ED (mean centerline shift: 37.1%-24.5%, benchmark 5.8%) and IP (28.4%-17.7%, benchmark 9.1%). Project mean ED viral testing decreased from 42.6% to 25.4% after revealing special cause with a 3.9% benchmark, whereas chest radiography (30.9%), antibiotic use (6.2%), and steroid use (7.6%) in the ED units did not change. IP steroid use decreased from 7.2% to 4.0% after special cause with 0.0% as the benchmark. Within-site ED and IP performance was modestly correlated. CONCLUSIONS: Collaboration between ED and IP units was associated with a decreased use of unnecessary tests and therapies in bronchiolitis; top performers used few unnecessary tests or treatments.

Original languageEnglish (US)
Article numbere20170830
JournalPediatrics
Volume141
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

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Bronchiolitis
Hospital Emergency Service
Inpatients
Benchmarking
Viral Bronchiolitis
Steroids
Bronchodilator Agents
Radiography
Lung Diseases
Heart Diseases
Chronic Disease
Thorax
Therapeutics
Anti-Bacterial Agents
Physicians

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Mussman, G. M., Lossius, M., Wasif, F., Bennett, J., Shadman, K. A., Walley, S. C., ... Ralston, S. (2018). Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care. Pediatrics, 141(2), [e20170830]. https://doi.org/10.1542/peds.2017-0830

Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care. / Mussman, Grant M.; Lossius, Michele; Wasif, Faiza; Bennett, Jeffrey; Shadman, Kristin A.; Walley, Susan C.; Destino, Lauren; Nichols, Elizabeth; Ralston, Shawn.

In: Pediatrics, Vol. 141, No. 2, e20170830, 01.02.2018.

Research output: Contribution to journalArticle

Mussman, GM, Lossius, M, Wasif, F, Bennett, J, Shadman, KA, Walley, SC, Destino, L, Nichols, E & Ralston, S 2018, 'Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care', Pediatrics, vol. 141, no. 2, e20170830. https://doi.org/10.1542/peds.2017-0830
Mussman GM, Lossius M, Wasif F, Bennett J, Shadman KA, Walley SC et al. Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care. Pediatrics. 2018 Feb 1;141(2). e20170830. https://doi.org/10.1542/peds.2017-0830
Mussman, Grant M. ; Lossius, Michele ; Wasif, Faiza ; Bennett, Jeffrey ; Shadman, Kristin A. ; Walley, Susan C. ; Destino, Lauren ; Nichols, Elizabeth ; Ralston, Shawn. / Multisite emergency department inpatient collaborative to reduce unnecessary bronchiolitis care. In: Pediatrics. 2018 ; Vol. 141, No. 2.
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