Pediatric Bronchiolitis Quality Improvement
Condition: Bronchiolitis
MeSH terms: Bronchiolitis
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Bronchiolitis quality improvement
Intervention type(s): Other
Intervention description(s): Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: The investigators will conduct a quality improvement process for all children diagnosed with bronchiolitis at our hospital who meet inclusion criteria. Outcomes for these patients will be compared with retrospective controls.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Bronchiolitis; Children; Hospital