WIP 14 - Reducing Harmful Interventions in the Diagnosis and Treatment of Bronchiolitis within Community ED and Inpatient Settings

Publication Number: WIP 14.7615

Micaylen Wolf, Southern Illinois University School of Medicine, Springfield, IL, United States; Kerby Scanlan, Southern Illinois University School of Medicine, Springfield, IL, United States; Fiyinfoluwa Soluade, Southern Illinois University School of Medicine, Rochester, IL, United States; Myto Duong, Southern Illinois University School of Medicine, Springfield, IL, United States; Mary Katherine Siebenaler, Southern Illinois University School of Medicine, Springfield, IL, United States; Sarah G. Majcina, Southern Illinois University School of Medicine, Springfield, IL, United States

Background: Bronchiolitis-related admissions surged by 75% during the 2022-2023 viral season as compared to the median admission rates from the 2010-2019 seasons. This increase highlights the importance of provider adherence to the American Academy of Pediatrics (AAP) Clinical Guidelines in order to reduce unnecessary, and potentially harmful, interventions. Despite the AAP’s clear recommendations, the use of routine chest radiographs, viral testing, albuterol, and systemic steroids is still commonly performed within the emergency department and inpatient settings.

Objective: Through the development and implementation of a standardized, evidence-based diagnostic and treatment protocol, we aim to decrease the use of unnecessary, harmful interventions in infants presenting with bronchiolitis at our community ED and hospital to 15% over 16 months.

Design/Methods: An institutional IRB was approved for this QI project. Data was collected on patients aged 30-days to 23-months who presented to our community ED with bronchiolitis (based upon ICD-10 codes) during the baseline period (11/2019-03/2020) and will be throughout the interventional period (11/2023-03/2024). Exclusionary criteria include: transfer patients, born < 32 weeks, cardiac disease, chronic lung disease, baseline O2 requirement, CPAP/BiPAP/intubation. This serves to assess the use of chest radiographs, viral testing, albuterol, and systemic steroids with tracking performance every two weeks. Interventions include: creation and use of a standardized clinical pathway, development of informational posters, and educational sessions for faculty and residents. Our goal is to decrease use of chest radiographs, viral testing, albuterol, and systemic steroids to 15% over 16 months. The Plan-Do-Study-Act model will be used to measure improvement. Balancing measures will include: length of stay in the ED and 72-hour return rates. Measures will be followed on a statistical process chart. To identify change ideas, a key driver diagram will be created. Pareto charts will be used to determine the setting of interventions.