The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

RESULTS OF THE UTILIZATION OF A BRONCHIOLITIS CLINICAL PRACTICE GUIDELINE (CPG) IN FOUR INTERMOUNTAIN HEALTH CARE (IHC) REGIONAL MEDICAL CENTERS.

Julie Ballard BS RRT and Kim Bennion BS RRT, Respiratory Care Services, Primary Children's Medical Center, Salt Lake City, Utah.

Introduction:
 Primary Children's Medical Center (PCMC) is a 232-bed pediatric, tertiary, referral facility operated by the Intermountain Health Care Corporation (IHC) located in the intermountain west. PCMC had developed and utilized a bronchiolitis clinical practice guideline (CPG) for seven years. Three other IHC hospitals with relatively high volumes of bronchiolitis patients adopted the CPG, and a multi-disciplinary corporate committee was formed to assist with the implementation. The group was charged with leading the process of improved care for bronchiolitis inpatients with the initial goal being to decrease the inappropriate utilization of albuterol by 10% at each of the other 3 facilities (PCMC was the benchmark and referral center). A standing admit order (SAO) was adopted and each hospital was responsible for establishing their own education with various committee members offering inservices.

Methods:
Data were extracted from the corporation's administrative data (case mix files) and detailed transactional data (billing) and include: (1) total number of non-intensive care (ICU) bronchiolitis patients (pts) < 24 months of age admitted to each facility by season (November 1- April 30), (2) % of all pts on albuterol txs, (3) mean number of albuterol (alb) treatments (txs) averaged for all pts, (4) mean length of stay (LOS) in hours, and (5) % decrease in alb use.

RESULTS:
Outcomes are reported by facility and season in Table 1.

CONCLUSION: 
In standardizing ordering practices, assessing pt response to interventions and utilizing a clearly defined CPG, we have been able to decrease ineffective inhaled albuterol txs for bronchiolitis inpatients at 4 Utah medical centers. The other facilities were afforded the opportunity to use an existing bronchiolitis CPG, avoiding duplication of guideline development. It is our impression that the data reported should be representative of the spectrum of pts with bronchiolitis <24 months of age requiring non-ICU admission, as all patients filling those criteria were included. Further improvement in the areas of chest radiography & lab/micro studies will be addressed. We continue to support hydration, oxygenation & NPS as the mainstays of care for bronchiolitis pts. 

Table 1: Comparison of albuterol usage and LOS after CPG implementation

  PCMC Hospital one (400 bed) Hospital Two (450 bed) Hospital Three (150 bed)
Season 99-00 00-01 01-02 99- 00 00-01 01-02 99-00 00-01 01-02 99-00 00-01 01-02
# Pts admitted 641 521 746 238 251 300 361 230 284 127 91 130
% Pts on alb txs 50 46 51 84 77 85 75 70 68 88 68 65
Mean # alb txs/pt 3.1 2.5 3.1 12 6.8 5.9 6 5.3 4.4 17 9.6 5.6
LOS (hrs) 74 71 74 62 52 53 77 70 68 91 85 81
% ¯ alb use Benchmark 13% 17% 42%

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