Pediatric Bronchiolitis Quality Improvement

Bronchiolitis Clinical Trial

Official title:

Pediatric Bronchiolitis Quality Improvement to Reduce Unnecessary Use of Diagnostic Testing and Treatment

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03528083
• Other study ID #: 1219188
• Status: Completed
• Phase: N/A
• Start date: May 31, 2018
• Est. completion date: December 31, 2021

Study information

• Verified date: May 2022
• Source: University of California, Davis
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Bronchiolitis is a respiratory illness characterized by acute inflammation of the airways, typically caused by a virus. By definition, it impacts children between 2 months and 2 years of age and is the most common cause of hospitalization among infants in the first year of life (American Academy of Pediatrics). Children with this illness may exhibit respiratory distress, as well as symptoms of viral respiratory illness, such as sneezing, nasal congestion, and cough. Often, hospitalization is required for respiratory distress and to support hydration needs.

Evidence based guidelines for the treatment of acute viral bronchiolitis primarily involve supportive care, which most often includes supplemental oxygen, hydration, and suctioning of secretions. However, in practice, bronchiolitis care is highly variable, often involving therapies such as inhaled bronchodilators, systemic corticosteroids, inhaled hypertonic saline, continuous pulse oximetry, chest physiotherapy, antibacterial medications, and use of intravenous fluids, all of which have been shown to be unnecessary and costly. Unnecessary care remains although multiple published quality improvement studies centered on acute bronchiolitis have proven successful. Quality improvement interventions have shown reduced use of unnecessary treatments and reduced resource allocation. Therefore, the investigators will conduct a quality improvement process to improve adherence to bronchiolitis treatment guidelines for children with bronchiolitis treated at University of California Davis Children's Hospital.

Description:

A multidisciplinary team, involving pediatric hospitalists, pediatric emergency physicians, residents, medical students, nurses and nurse managers, and respiratory therapists will be assembled. The investigators will participate in a value stream mapping process, to map out the current pediatric bronchiolitis care process and identify areas for improvement in efficiency and effectiveness. The investigators will then begin the iterative process of implementing improvements to the bronchiolitis care process. Interventions will be evidence-based and designed to improve compliance with bronchiolitis care guidelines, as set forth by the American Academy of Pediatrics. Examples of possible interventions may include creation of a bronchiolitis admission order set, implementation of an evidence-based bronchiolitis clinical pathway, and/or institution of standardized bronchiolitis discharge criteria. Interventions will be implemented in a stepwise fashion, utilizing successive plan-do-study-act cycles, with a minimum 2 month period between interventions to monitor outcomes. The investigators will track utilization of diagnostic testing and treatments within our intervention group, as compared to historical controls who also meet inclusion criteria.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1321
• Est. completion date: December 31, 2021
• Est. primary completion date: May 30, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 2 Years

Eligibility

Inclusion Criteria:

• Children less than 2 years of age admitted to UC Davis Children's Hospital with any diagnosis of bronchiolitis

Exclusion Criteria:

• Children or adults greater than 2 years of age

• Children born at less than 35 weeks gestational age

• Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies

Related Conditions & MeSH terms

• Bronchiolitis

Intervention

Other:
• Bronchiolitis quality improvement
Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.

Locations

Country	Name	City	State
United States	UC David Medical Center	Sacramento	California

Sponsors (1)

Lead Sponsor	Collaborator
University of California, Davis

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Chest x-ray utilization	Percentage of patients meeting inclusion criteria who received a chest x-ray	Through study completion, an average of 19 months
Primary	Antibiotic utilization	Percentage of patients meeting inclusion criteria who received antibiotics	Through study completion, an average of 19 months
Primary	Bronchodilator utilization	Percentage of patients meeting inclusion criteria who received bronchodilators	Through study completion, an average of 19 months
Primary	Steroid utilization	Percentage of patients meeting inclusion criteria who received steroids	Through study completion, an average of 19 months
Primary	Hypertonic saline utilization	Percentage of patients meeting inclusion criteria who received nebulized hypertonic saline.	Through study completion, an average of 19 months
Primary	Chest physiotherapy utilization	Percentage of patients meeting inclusion criteria who received chest physiotherapy	Through study completion, an average of 19 months
Primary	Intravenous fluid utilization	Percentage of patients meeting inclusion criteria who received intravenous fluid	Through study completion, an average of 19 months
Primary	Continuous pulse oximetry utilization	Percentage of patients meeting inclusion criteria who received continuous pulse oximetry	Through study completion, an average of 19 months
Primary	Supplemental oxygen utilization	Percentage of patients meeting inclusion criteria who received supplemental oxygen	Through study completion, an average of 19 months
Secondary	Length of stay index	A ratio of observed to expected length of stay for patients admitted with bronchiolitis, as compared to national standards	Through study completion, an average of 19 months
Secondary	Readmission rate	Same hospital readmission rate for patients with a diagnosis of bronchiolitis	Within 30 days following the index hospitalization discharge date
Secondary	Emergency room revisit rate	Same hospital emergency room revisit rate for patients with a diagnosis of bronchiolitis	Within 30 days following the index hospitalization discharge date
Secondary	Bronchiolitis specific discharge instructions	Percentage of patients meeting inclusion criteria who received bronchiolitis specific handout containing care instructions on discharge	Through study completion, an average of 19 months
Secondary	Timely completion of discharge summary	Percentage of patients meeting inclusion criteria who had a discharge summary completed	Within 48 hours of discharge from the index hospitalization
Secondary	Timely routing of discharge summary	Percentage of patients meeting inclusion criteria who had a discharge summary routed to their primary care provider	Within 48 hours of discharge from the index hospitalization
Secondary	CC capture rate	The capture rate for comorbid conditions within our charting for patients diagnosed with bronchiolitis	Through study completion, an average of 19 months
Secondary	MCC capture rate	The capture rate for major comorbid conditions within our charting for patients diagnosed with bronchiolitis	Through study completion, an average of 19 months