title: Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis.
abstract: OBJECTIVE
  Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED).
  
  
  METHODS
  We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).
  
  
  RESULTS
  There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.
  
  
  CONCLUSIONS
  A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.
authors: MBChB, Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. ayobami.akenroye@childrens.harvard.edu.
authors: Ayobami T
authors: AT
authors: Akenroye
authors: Marc N
authors: MN
authors: Baskin
authors: Mihail
authors: M
authors: Samnaliev
authors: Anne M
authors: AM
authors: Stack
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001900:Boston; D001988:Bronchiolitis / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D012044:Regression Analysis; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: bronchiolitis; costs; guidelines; pediatric emergency; resource utilization