The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

DETERMINING PATIENT ADMISSION CRITERIA TO AN OUTPATIENT NASOPHARYNGEAL SUCTIONING & INHALED MEDICATION TREATMENT PROGRAM FOR THE CARE OF BRONCHIOLITIS PATIENTS

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

Introduction:
We have long believed that hydration, oxygenation & nasopharyngeal suctioning (NPS) are the mainstays of care for bronchiolitis patients (pt). Our facility uses a bronchiolitis clinical practice guideline (CPG) on bronchiolitis inpatients. The CPG includes a previously described symptom-based bronchiolitis score (BS) where respiratory rate, breath sounds & retractions are each scored on a 0-3 scale. The BS is used to define respiratory distress & pt response to interventions. We implemented the CPG in an outpatient (OP) setting allowing us to treat lower acuity pts with NPS and/or inhaled medications via small volume nebulizer without being admitted. We sought to assess what if any standard our physicians used as pt admission criteria to the OP program. Physicians were given the details of the program and a standardized order form prior to the start of the season (Nov. 1-April 30).

Methods:
. Inclusion criteria were: (1) all pts with a diagnosis of bronchiolitis admitted to the OP program by referral from physician offices, the Emergency Room or as ordered when discharged from the hospital, (2) age < 24 months, (3) assigned a baseline BS on their initial OP visit, and (4) received at least 1 NPS event with a BS pre- & post- NPS.

Results: Although 93 pts were seen in the OP clinic, 9 were excluded due to insufficient scores, leaving us 84 pts to study. Outcomes are reported in Table One.

Table One: Outcomes of Outpatients Treated in the Outpatient Bronchiolitis Program 84 Pts.
# (%) Referred from Physician’s Office 45 (54)
# (%) Referred from Emergency Department 22 (26)
# (%) Referred from Hospital Discharge 17 (20)
# (%) Initial BS 0-1 (normal respiratory distress) 12 (14)
# (%) Initial BS 2-3 (mild respiratory distress) 55 (66)
# (%) Initial BS 4-6 (moderate respiratory distress) 17 (20)
# (%) Initial BS 7-9 (severe respiratory distress) 0 (0)
Mean (range) distance in miles from pts hometown to OP Program 8.6 (0-65)
# (%) Pts improving post initial NPS (BS decreased by > 1 from baseline to post NPS score) 57 (68)

Discussion: We report no formal or informal untoward events among pts in our OP program. Surveys have been sent to the referring physicians in an effort to ascertain if other factors may have influenced a physician’s decision to admit to the OP program such as: ability to pay, pts home in proximity to the hospital, and parent request. Surveys were also sent to the pt’s caregivers. Results will be tallied & reported in an effort to identify areas for education &/or process improvement. It is our impression that low acuity bronchiolitis pts can be safely cared for in an OP setting and that physicians did select appropriate pts for the program per initial BS. This program may have increased bed space availability. Further study is needed before conclusions can be made.

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