A multidisciplinary improvement initiative can reduce overuse of interventions for bronchiolitis, according to a study published online in Pediatrics.

The American Academy of Pediatrics published bronchiolitis clinical practice guidelines in 2014 recommending against the routine use of bronchodilators, chest radiographs, or respiratory viral testing in children with a clinical diagnosis of bronchiolitis. Our aim in this project was to align care with the American Academy of Pediatrics clinical practice guidelines by decreasing the overuse of these interventions.

In an effort to reduce overuse of interventions for children with a clinical diagnosis of bronchiolitis, Amy Tyler, and colleagues used a multidisciplinary event to initiate the examination of the problem and develop interventions for patients admitted to a non-intensive care unit setting with a primary or secondary diagnosis of bronchiolitis. The interventions included sharing provider-specific data and asking providers to pledge to reduce use. Data were collected and analyzed using a real-time data dashboard.

Improvement of Outcomes 

The researchers found that during the intervention season there was the improvement for all outcomes for inpatients. Comparing baseline to intervention values for all admitted patients and patients who were discharged from the emergency department or urgent care, there was a significant decrease in the ordering of chest radiographs (from 22.7 to 13.6%), respiratory viral testing (from 12.5 to 9.8%), and bronchodilators (from 17.5 to 10.3%), with no changes in balancing measures for bronchiolitis.

"This multidisciplinary improvement initiative resulted in a significant reduction in use for bronchiolitis care at our institution," the authors write. "Our approach, which included a novel, real-time data dashboard, and interventions such as individual providers pledging to reduce use, may have the potential to reduce overuse in other settings and diseases."