132 - Sustaining Improvements: How Long-Standing Improvements in Bronchiolitis Care Weathered the COVID-19 Pandemic

Poster Number: 132
Publication Number: 132.415

John D. Watson, Children's Hospital Colorado, Denver, CO, United States; Elise K. Rolison, Childrens’s Hospital Colorado, Arvada, CO, United States; Sarah L. Pihl, Children's Hospital Colorado, Denver, CO, United States; Amy Tyler, University of Colorado School of Medicine, Aurora, CO, United States

Background: The COVID-19 pandemic disrupted many aspects of our clinical practice, but little is known about its effect on established quality improvement (QI) work. From December 2015 to April 2016, we conducted a QI initiative to align our hospital’s practices with the 2014 American Academy of Pediatrics Bronchiolitis Clinical Practice Guideline. Specifically, we worked to decrease the use of bronchodilators, chest x-rays (CXRs), and viral pathogen panel testing (RPP) in patients under two years of age with bronchiolitis. The 1-year QI project resulted in significant reductions in all targeted tests/treatments, and the improvements were sustained for a 4-year period (2016-2020) following the initial project.

Objective: To describe the effect of the COVID-19 pandemic on sustained improvement in bronchiolitis care. Specifically, to describe changes in the proportion of bronchiolitis patients receiving unwarranted interventions (bronchodilators, CXRs, RPP) after the start of the pandemic in March 2020.

Design/Methods: Patients aged 1-23 months with any diagnosis of bronchiolitis admitted during bronchiolitis season (December-April) were included. Patients requiring intensive care and patients with underlying cardiopulmonary disease, prematurity, immunodeficiency, and sepsis were excluded. Real-time data collection and analysis in the form of a project dashboard was used to monitor the use of targeted tests/treatments. To sustain improvement after the initial QI project, monthly multidisciplinary meetings were held to review and share data and develop and implement improvement strategies as necessary. Sustainment strategies included project champion distribution of education and reminder emails to team members at the start of each season and quarterly or monthly data sharing. Additional post-pandemic strategies included: updating our existing institutional clinical pathway and order sets and distributing water bottles displaying our project slogan.

Results: During the early COVID-19 pandemic, we saw an increase in the ordering of all targeted tests/treatments: bronchodilators (Figure 1), CXRs (Figure 2), and RPPs (Figure 3). Using above strategies, we have seen a decrease to near pre-pandemic levels.Conclusion(s): The COVID-19 pandemic was disruptive to the long-established control of this bronchiolitis quality improvement project, but the use of targeted tests/treatments are now decreasing to pre-COVID-19 levels. Established quality improvement projects should be vigilant of backsliding during the pandemic, and control can be regained with simple but effective strategies.
Figure 1
Figure 2