The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

THE UTILIZATION OF CHEST RADIOGRAPHY, COMPLETE BLOOD COUNT, BLOOD CULTURES & ANTIBIOTICS IN THE CARE OF BRONCHIOLITIS PATIENTS.

Kim Bennion BS RRT, Julie Ballard BS RRT, Debbie Forbush BS CRT and Scott Daniel RRT. Respiratory Care Services, Dixie Regional Medical Center, St. George, Utah.

Introduction:
Our facility is a 150-bed regional medical center of the Intermountain Health Care Corporation (IHC) located in southern Utah. We chose to utilize a bronchiolitis clinical practice guideline (CPG) to assist us in standardizing physician ordering practices and decreasing ineffective therapies. In reviewing the charts of all bronchiolitis patients admitted to our hospital from November 1, 2002 through April 30, 2003 (the months in which the majority of our bronchiolitis patients were admitted), we identified what appeared to be an over utilization of certain interventions. We sought to determine how frequently chest radiography (CXR), complete blood count (CBC), and/or blood cultures (BC) were ordered and if the results of these tests would produce outcomes that might require additional treatment. In short, we sought to determine if the results of these additional interventions would identify the further need to treat with antibiotics.1

Methods:
A CPG for bronchiolitis was introduced and was defined by a standing admit order (SAO) sheet which was to be used by the admitting physician when a bronchiolitis patient (pt) was admitted. The CPG was based on the latest evidence-based practices for the care of bronchiolitis patients and did not include the routine utilization of CXR, CBC, BC & antibiotics (ABX). Inclusion criteria for our study were: (1) primary diagnosis of bronchiolitis, (2) age < 24 months, and (3) CXR, CBC, BC and/or ABX at anytime during their admit. Data elements collected on these patients included CXR, CBC, BC and ABX use as well as results.

RESULTS:
There were 45 pts who met the criteria. Our findings are reported in Table 1.

CONCLUSION:
We have identified an over utilization of CXR, CBC, BC and ABX use within our facility. The low incidence of positive findings in this study of patients leaves us to conclude that these practices offer little if any benefit in the treatment of uncomplicated bronchiolitis patients.

 Table 1: CXR, CBC, BC & ABX Utilization & Results

Test # (%) Patients Positive Results # (%)
CXR 37 (82) 2 (5) had a noted focal infiltrate/consolidation
CBC 38(84) 9 (25) had any abnormal value*
BC 26 (58) 1 (4) was + for staph epidermis
ABX 22 (49) N/A


4 (44) abnormal results were low HCT/Hgb

1Everard ML. Bronchiolitis-origins and optimal management. Drugs 1995;49 (6)

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