title: An evidence-based clinical pathway for bronchiolitis safely reduces antibiotic overuse.
abstract: The overuse of antibiotics in the management of bronchiolitis is widely known, yet physician practice has been slow to change. We report here on the success of a clinical pathway in reducing antibiotic overuse in the inpatient management of bronchiolitis. The charts of 181 children admitted for bronchiolitis were reviewed to determine whether antibiotic use was reduced in patients managed using a clinical pathway compared with a matched group of patients managed without use of the pathway (non-pathway group). Only 9% of the pathway patients received antibiotics compared with 27% of the nonpathway group. No negative effects were seen on other quality measures including unplanned return for care. Furthermore, for patients managed using the clinical pathway, cost and length of stay were significantly reduced. Overall, the study suggests that implementation of a clinical pathway may be an effective means to change physician practice and reduce the unnecessary use of antibiotics, while maintaining or improving other aspects of quality of care.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, 94143, USA. swilson@itsa.ucsf.edu
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wilson
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Dahl
authors.forename: Robert D
authors.initials: RD
authors.lastname: Wells
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000188:drug therapy* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways / Q000592:standards*; D004363:Drug Utilization; D019317:Evidence-Based Medicine / Q000592:standards*; D006744:Hospital Bed Capacity, 100 to 299; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000592:standards; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration
chemical_list: D000900:Anti-Bacterial Agents