Clinical trial NCT03528083: Pediatric Bronchiolitis Quality Improvement
Official title: Pediatric Bronchiolitis Quality Improvement to Reduce Unnecessary Use of Diagnostic Testing and Treatment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Bronchiolitis
Keywords: Bronchiolitis
Children
Hospital
Lead sponsor: University of California, Davis
Sponsor class: OTHER
First posted: 2018-05-17
Enrollment: 1321
Sex: ALL
Minimum age (years): 1
Maximum age (years): 2
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
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.
Primary purpose: SUPPORTIVE_CARE

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Children less than 2 years of age admitted to UC Davis Children's Hospital with any diagnosis of bronchiolitis

Exclusion Criteria:

* Children or adults greater than 2 years of age
* Children born at less than 35 weeks gestational age
* Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies

Primary outcomes:
measure: Chest x-ray utilization
timeFrame: Through study completion, an average of 19 months
measure: Antibiotic utilization
timeFrame: Through study completion, an average of 19 months
measure: Bronchodilator utilization
timeFrame: Through study completion, an average of 19 months
measure: Steroid utilization
timeFrame: Through study completion, an average of 19 months
measure: Hypertonic saline utilization
timeFrame: Through study completion, an average of 19 months
measure: Chest physiotherapy utilization
timeFrame: Through study completion, an average of 19 months
measure: Intravenous fluid utilization
timeFrame: Through study completion, an average of 19 months
measure: Continuous pulse oximetry utilization
timeFrame: Through study completion, an average of 19 months
measure: Supplemental oxygen utilization
timeFrame: Through study completion, an average of 19 months
Secondary outcomes:
measure: Length of stay index
timeFrame: Through study completion, an average of 19 months
measure: Readmission rate
timeFrame: Within 30 days following the index hospitalization discharge date
measure: Emergency room revisit rate
timeFrame: Within 30 days following the index hospitalization discharge date
measure: Bronchiolitis specific discharge instructions
timeFrame: Through study completion, an average of 19 months
measure: Timely completion of discharge summary
timeFrame: Within 48 hours of discharge from the index hospitalization
measure: Timely routing of discharge summary
timeFrame: Within 48 hours of discharge from the index hospitalization
measure: CC capture rate
timeFrame: Through study completion, an average of 19 months
measure: MCC capture rate
timeFrame: Through study completion, an average of 19 months
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: UC David Medical Center
state: California
Study officials:
affiliation: University of California, Davis
name: Michelle Hamline, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: