The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

DETERMINING PATIENT ADMISSION CRITERIA TO A BRONCHIOLITIS OUTPATIENT CLINIC (B0C): 3 SEASONS IN REVIEW

Kimberly J. Bennion3,1, Julie Ballard2,1, Scott Daniel1, Debbie Forbush1



Introduction: We initially implemented & reported (1) on a BOC utilized during the 2003-2004 respiratory season (November 1 of one year through April 30 of the next). The existing inpatient bronchiolitis clinical practice guideline (CPG) emphasizes nasopharyngeal suction (NPS), oxygenation & hydration as the mainstays of care for bronchiolitis & utilizes a symptom-based bronchiolitis score (BS) where respiratory rate, breath sounds & retractions are each scored on a 0-3 scale. The total BS is used to define respiratory distress (RD) & pt response to interventions (NPS &/or inhaled medications via small volume nebulizer). We sought to further compare 3 seasons of BOC utilization in regards to what if any standard physicians (MDs) used as pt admission criteria to the BOC, pt distance from hometown to BOC& the response to interventions. We attempted to identify if the former had changed as the program matured.

Methods: Inclusion criteria were:

  1. all pts with a primary diagnosis of bronchiolitis admitted to the BOC by referral from MD offices, Emergency Department (ED) or as ordered when discharged (DC) from the hospital,
  2. age < 24 months,
  3. assigned a baseline BS on their initial BOC visit, &
  4. received at least 1 NPS event with a BS pre- & post-NPS. Results: Three seasons of outcomes are reported in Table One. Pts with zip codes > 100 miles from the hospital were excluded.
Discussion: We report no formal or informal untoward events among pts treated in the BOC. It is our impression that pts in mild to moderate distress (BS 2-4 post NPS) can be safely cared for in a BOC setting. MDs appear to be referring a higher number of pts with normal RD (BS 0-1) to the clinic & probably accounts for the decrease in pts improving post NPS. Investigating this led us to discover that several of the community clinics are referring any pt suspected of bronchiolitis to the BOC despite severity of RD. BOC admission criteria will be clarified with MDs prior to the 2008-2009 season. The impact of BOC implementation on hospital admissions is reported in an additional abstract. A manuscript with detailed outcomes of the BOC is being written. An application for the Joint Commission's Codman Award for Quality Excellence has been submitted at the time of the writing of this abstract. Five additional corporate hospitals covering geographical areas across the state of Utah opened BOCs in January of 2008.
(1)AARC Abstract;2004;49:1439