The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

THE USE OF ACHEST X-RAY (CXR) IN THE TREATMENT OF BRONCHIOLITIS PATIENTS

Kim BennionRRT, BS, Julie Ballard RRT, BS, QCAT Team Members and John Salyer RRT, MBA,FAARC. Respiratory Care Service, Primary Children?s Medical Center, School ofMedicine, University of Utah.

Introduction:Our hospital has a multi-disciplinary assessment team that specializes in careof bronchiolitis pts. The team is called the Quality Care Assessment Team (QCAT)and has 7 specially trained RCPs who daily assess all pts receiving any respiratoryinterventions. The team employs standardized protocols for treatment. A standingadmit order (SAO) sheet is used by the physician when admitting a pt to a non-intensivecare unit. The utilization of a CXR is not included on the SAO; therefore, aphysician must order this separately. CXR is not generally recommended in uncomplicatedbronchiolitis.1,2 Nevertheless an unwarranted variation in orderingpractices seems to exist at our hospital. We sought to determine CXR utilizationand it?s relationship to other aspects of care.

Method:Data were retrospectively extracted from our data systems for the 2000-2001bronchiolitis season. Inclusion criteria were (1) primary diagnosis bronchiolitis,(2) age < 24 months, (3) only non-ICU pts and (4) APR/DRG severityof illness level of 1 (the mildest). Seeking to compare only truly uncomplicatedbronchiolitics, we further excluded patients who had congenital heart disease,upper airway anomalies, cystic fibrosis, bronchopulmonary dysplasia and immuno-compromiseddisease states. Data elements included CXR utilization, length of stay in hrs(LOS), number of nebulized bronchodilator and CPT treatments, and hospitalscosts and charges. Mean differences were tested using Mann-Whitney U test, withsignificance set at P<0.05.

Results: Ofthe 580 patients who met the diagnostic criteria, 52 were excluded based onpre-existing factors leaving 528 pts. We further excluded 338 due to APR/DRGseverity level >1, leaving 190 pts. CXR was utilized in 42% of these lowseverity pts.

Discussion:This method of selecting pts should produce a fairly homogenous sample of lowseverity bronchiolitis pts. Yet 42% had a CXR. If the CXR group had indeed beensicker, we would have expected to see more respiratory interventions, yet wedid not. It might be argued that the increased LOS in the CXR group indicatesincreased severity, but could also be explained by unwarranted practice variation.It is interesting to note that no pts in either group had any CPT. In recentyears we have seen some improvement in CXR utilization, yet it still seems inappropriatelyhigh, especially in this group.

1 Paediatr. Child Health 1993:29:335-337

2 Pediatrics 1999;104;6:1334-1341

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