The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Kimberly J. Bennion1,3, Julie Ballard2,3, Scott Daniel3, Debbie Forbush3

Introduction: We initially implemented a Bronchiolitis Outpatient Clinic (BOC) 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. The CPG utilizes a symptom-based bronchiolitis score (BS) to define respiratory distress (RD) & pt response to interventions (NPS &/or inhaled medications). We utilized Certified Respiratory Therapy students (CRT) to staff the BOC for a semester. Students worked 7 days/week from 1000 to 2200 during January 1, 2007 to April 30, 2007. CRTs were instructed in the bronchiolitis CPG to include the standard for scoring, NPS & delivery of inhaled medications.
We sought to compare 2 data points:

  1. the completion of scoring by the CRTs with a complete score defined as a baseline & post intervention, &
  2. if the improvement in the BS could be reproduced when utilized by CRTs with limited pediatric experience. An improvement in RD is defined as a decrease in the BS by >= 1 from baseline to post intervention (NPS).
Methods: Inclusion criteria were:
  1. all pts with a primary diagnosis of bronchiolitis treated in the BOC during Jan 1 to April 30 of 2006, 2007 & 2008, &
  2. pt age < 24 months.
Results: Comparisons are reported in Table One with P-value <0.05 per Chi-Square Analysis(*).

Discussion: The CRTs reported a greater understanding of a detailed respiratory, pediatric assessment after their semester in the BOC. Experienced therapists were able to care for pts in the intensive care units with the utilization of CRTs in the BOC. We report no untoward events with the utilization of CRTs. Though not a rigorously validated score, the BS appears to be an easy, reliable tool to use for assessing RD & response to interventions in bronchiolitis pts. Initial attempts at validating the score were reported in an earlier abstract (1), but further validation of the score is planned for the 2008-2009 season. A manuscript of additional outcomes of BOC implementation is being written, & an application for the Joint Commission's Codman Award for Quality Excellence has been submitted. Five additional corporate hospitals covering geographical areas across the state of Utah opened BOCs in January of 2008.

(1)AARC Abstract, 2001;46:1118