Empowering respiratory therapists to take a more active role in delivering quality care for infants with bronchiolitis.
BACKGROUND
Cincinnati Children's Hospital Medical Center developed a bronchiolitis-treatment guideline and implemented a program, led by respiratory therapists, to encourage the use of respiratory function assessment to determine the need for and effect of bronchodilator treatment of infant bronchiolitis patients.


METHODS
The program was implemented on January 14, 2002, and included (1). a revised respiratory scoring form, (2). a change in the respiratory score threshold for a recommendation of bronchodilator treatment, (3). establishment of multidisciplinary rounds, (4). providing current data to the respiratory therapists, and (5). increasing effective data-based communication between the respiratory therapists and physicians. Guideline-eligible patients admitted before the implementation of the program (between 12/1/01 and 1/13/02) were compared to patients admitted during the program (between 1/14/02 and 3/31/02). We compared the mean numbers of bronchodilator treatments per patient in fiscal years 2001 and 2002. We defined "perfect respiratory care" as administration of bronchodilator only if preceded by suction treatment that resulted in a post-suction respiratory score >or= 3.


RESULTS
Documentation of respiratory scoring significantly increased following implementation of the program, as did "perfect respiratory care." Between the 2001 and 2002 bronchiolitis seasons, there was a decrease in both the mean number and the variability in the number of bronchodilator doses administered.


CONCLUSIONS
Expanding guideline recommendations to the level of specific protocols and empowering respiratory therapists to take a more active role improve the quality of care for infant bronchiolitis patients.
Conway
Edward
E
Department of Respiratory Care, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. ed.conway@cchmc.org.
Schoettker
Pamela J
PJ
Moore
Amy
A
Britto
Maria T
MT
Kotagal
Uma R
UR
Rich
Kate
K
D000465:Algorithms; D001988:Bronchiolitis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D024382:Professional Role; D016730:Program Development / Q000379:methods*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D012129:Respiratory Function Tests / Q000592:standards; D012138:Respiratory Therapy / Q000379:methods*
D001993:Bronchodilator Agents