Sustaining the implementation of an evidence-based guideline for bronchiolitis.
OBJECTIVE
To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis.


METHODS
Before and after study.


METHODS
Children's Hospital Medical Center, Cincinnati, Ohio.


METHODS
Infants 1 year or younger admitted to the hospital with a first-time episode of typical bronchiolitis.


METHODS
The guideline was implemented January 15, 1997. Data on all patients discharged from the hospital with bronchiolitis, from January 15 through March 27, in 1997, 1998, and 1999, were stratified by year and compared with data on similar patients discharged from the hospital in the same periods in the years 1993 through 1996.


METHODS
Patient volumes, length of stay for admissions, and use of specific laboratory and therapeutic resources ancillary to bed occupancy.


RESULTS
After implementation of the guideline, admissions decreased 30% and mean length of stay decreased 17% (P<.001). Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients (P<.001); 14% fewer chest x-ray films were ordered (P<.001). There were significant reductions in the use of all respiratory therapies, with a 17% decrease in the use of at least 1 beta(2)-agonist inhalation therapy (P<.001). In addition, 28% fewer repeated inhalations were administered (P<.001); mean costs for all resources ancillary to bed occupancy fell 41% (P<.001); and mean costs for respiratory care services fell 72% (P<.001).


CONCLUSIONS
An evidence-based clinical practice guideline for the care of patients encountered in major pediatric care facility has been successfully sustained beyond the initial year of its introduction to practitioners in southwest Ohio.
Perlstein
P H
PH
Division of Health Policy and Clinical Effectiveness, Children's Hospital Medical Center, Cincinnati, OH, USA. Uma.Kotagal@UC.edu.
Kotagal
U R
UR
Schoettker
P J
PJ
Atherton
H D
HD
Farrell
M K
MK
Gerhardt
W E
WE
Alfaro
M P
MP
D000465:Algorithms; D001509:Bed Occupancy; D001988:Bronchiolitis / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D003663:Decision Trees; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009820:Ohio; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*