title: Inpatient bronchiolitis guideline implementation and resource utilization.
abstract: BACKGROUND
  Provider-dependent practice variation in children hospitalized with bronchiolitis is not uncommon. Clinical practice guidelines (CPGs) can streamline practice and reduce utilization however, CPG implementation is complex.
  
  
  METHODS
  A multidisciplinary team developed and implemented CPGs for management of bronchiolitis for children <2 years old. Children with comorbidities, ICU admissions, and outside hospital transfers were excluded. Implementation involved teamwork and collaboration, provider education, online access to CPGs, order sets, data sharing, and monthly team meetings. Resource utilization was defined as use of chest x-rays (CXRs), antibiotics, steroids, and more than 2 doses of inhaled bronchodilator use. Outcome metrics included length of stay (LOS) and readmission rate. Bronchiolitis season was defined as September to April. Data were collected for 2 seasons post implementation.
  
  
  RESULTS
  The number CPG-eligible patients in the pre- and 2 postimplementation periods were similar (1244, preimplementation; 1159, postimplementation season 1; 1283 postimplementation season 2). CXRs decreased from 59.7% to 45.1% (P < .0001) in season 1 to 39% (P < .0001) in season 2. Bronchodilator use decreased from 27% to 20% (P < .01) in season 1 to 14% (P < .002) in season 2. Steroid use significantly reduced from 19% to 11% (P < .01). Antibiotic use did not change significantly (P = .16). LOS decreased from 2.3 to 1.8 days (P < .0001) in season 1 and 1.9 days (P < .05) in season 2. All-cause 7-day readmission rate did not change (P = .45).
  
  
  CONCLUSIONS
  Bronchiolitis CPG implementation resulted in reduced use of CXRs, bronchodilators, steroids, and LOS without affecting 7-day all-cause readmissions.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; and.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mittal
authors.forename: Cindy
authors.initials: C
authors.lastname: Darnell
authors.forename: Brian
authors.initials: B
authors.lastname: Walsh
authors.forename: Amit
authors.initials: A
authors.lastname: Mehta
authors.forename: Mohamed
authors.initials: M
authors.lastname: Badawy
authors.forename: Rustin
authors.initials: R
authors.lastname: Morse
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop
authors.forename: Jerithea
authors.initials: J
authors.lastname: Tidwell
authors.forename: Maeve
authors.initials: M
authors.lastname: Sheehan
authors.forename: Sandra
authors.initials: S
authors.lastname: McDermott
authors.forename: Carolyn
authors.initials: C
authors.lastname: Cannon
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kahn
mesh_terms: D026683:Advisory Committees; D001988:Bronchiolitis / Q000175:diagnosis* / Q000628:therapy*; D002675:Child, Preschool; D015331:Cohort Studies; D019983:Guideline Adherence / Q000592:standards*; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: bronchiolitis; clinical practice guidelines; resources utilization