380 - A Novel Standardization Initiative Greatly Improves Outcomes in Patients with Bronchiolitis

Poster Number: 380
Publication Number: 380.243

John J. Sarandria, Nemours Children's Hospital, Orlando, FL, United States; Andrea Rivera-Sepulveda, Nemours Children's Hospital, Orlando, FL, United States; David Conomon, Nemours Children's Hospital, St Cloud, FL, United States; Tamatha Henderson, Nemours Children's Hospital, Orlando, FL, United States; Jenny Hogue, Nemours Children's Hospital, Orlando, FL, United States

Background: Bronchiolitis is the most common diagnosis in children under 2 years of age. Historically, the management of this respiratory disorder varied greatly until multi-center data revealed that laboratory testing, imaging, and medications did not improve outcomes. In 2019, our medium sized academic hospital was experiencing higher surges in emergency room visits and patient admissions. Data analysis revealed that one of the largest areas of waste, lack of standardization, and patient overstay was surrounding the management of children with bronchiolitis.

Objective: Our primary aim was to reduce the unnecessary use of chest radiographs, albuterol use, and steroid administration for patients with bronchiolitis (2 months to 2 years old) by 20% within a 180-day period beginning February 2020 and ending August 2020.

Design/Methods: Key stakeholders assembled a multidisciplinary team to evaluate the existing workflow and develop a strategy to standardize both emergency room (ER) and inpatient processes. Our team developed a standardization initiative, which included a novel bronchiolitis scoring system and high flow weaning protocol, an education curriculum (for nursing staff, physicians, and residents), care algorithms, clinical pathways, and EMR tools (including smart phrases, note templates, and order sets).

Results: At the end of the 180-day mark, all outcome measures were met, and results exceeded expectations. Specifically, the use of chest radiographs in the ER declined by 69% (81% inpatient), the use of corticosteroids was reduced by 85%, and the use of albuterol in the ER was reduced by 70% (37.5% inpatient). Additionally, we were able to reduce the median time on high flow nasal cannula by 23% and reduce the average length of stay by 24%. There was no increase in readmission rate, ICU admissions, hypertonic saline use, or viral panel testing at 180 days.Conclusion(s): The bronchiolitis standardization initiative developed and implemented by our hospital's multidisciplinary team led to significant improvements in the standard of care for pediatric patients with a diagnosis of bronchiolitis. Our team sought to reach all areas of care to ensure adherence and lasting buy-in, which we believed we achieved through permanent system fixes (order sets, care algorithms, education curriculums for new hires, etc.) and a change in culture at our organization.
Albuterol Use in Bronchiolitis PatientsPercentage of patients with bronchiolitis treated with albuterol in the emergency department (ED) and inpatient (IP) units.
Corticosteroid Use in Bronchiolitis PatientsPercentage of patients with bronchiolitis treated with corticosteroids in the emergency department (ED).