Aim Bronchiolitis is a common lower respiratory tract infection of infancy where management has varied considerably in the past. The aim of the present study was to determine whether patient treatment and outcomes changed after introduction of a clinical care pathway.
Methods Infants aged up to six months admitted to hospital with bronchiolitis were identified as part of an annual audit of bronchiolitis management between winters 2003/4 and 2010/11. High risk infants, e.g. infants born prematurely or with cardiac defects, were excluded. The primary outcome, duration of stay (DOS), was compared before and after the clinical pathway was introduced before the winter 2005/6. Secondary outcomes were proportion requiring nasogastric feeds, supplemental oxygen and readmission within a week of discharge.
Results There were 382 infants identified, mean age 68 days, 55% were male and respiratory syncitial virus was detected in 84%. After the clinical pathway was introduced, the proportion of infants prescribed salbutamol fell from 50% to 10% (p<0.001) and ipratropium bromide from 38% to 6% (p<0.001) but the proportion prescribed antibiotics was unchanged. The median DOS was 79 hours prior to the clinical pathway and 60 hours afterwards (p<0.001) but there was no difference in the proportion requiring nasogastric feeds, supplemental oxygen or readmission.
Conclusions A clinical pathway for the management of acute bronchiolitis can be implemented in the hospital setting and the conservative approach, in particular cautious prescribing of bronchodilators, is not associated with prolonged duration of stay.