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Quality improvement
Initiatives to reduce treatments in bronchiolitis in the emergency department and primary care
  1. Marta Montejo1,
  2. Natalia Paniagua2,
  3. Carlos Saiz-Hernando3,
  4. Lorea Martinez-Indart4,
  5. Santiago Mintegi2,5,
  6. Javier Benito2,5
  1. 1 Rontegi-Barakaldo Primary Care Center, University of the Basque Country, Bilbao, Spain
  2. 2 Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
  3. 3 Department of Medical Documentation, Cruces University Hospital, Bilbao, Spain
  4. 4 Epidemiology Department, Cruces University Hospital, Bilbao, Spain
  5. 5 Department of Pediatrics, University of the Basque Country, Bilbao, Spain
  1. Correspondence to Dr Marta Montejo, Rontegi-Barakaldo Primary Care Center, University of the Basque Country, Bilbao 48940, Spain; Marta.montejofernandez{at}osakidetza.eus

Abstract

We performed a quality improvement initiative to reduce unnecessary treatments for acute bronchiolitis (AB) in primary care (PC) and the referral paediatric emergency department (ED). The quality improvement initiative involved two seasons: 2016–2017 (preintervention) and 2017–2018 (postintervention). We distributed an evidence-based protocol, informative posters and badges with the slogan ‘Bronchiolitis, less is more’. We also held interactive sessions, and paediatricians received weekly reports on bronchodilator prescription. The main outcome was the percentage of infants prescribed salbutamol. Secondary outcomes were epinephrine, antibiotic and corticosteroid prescription rates. Control measures were ED visit and hospitalisation rates, triage level, length of stay, intensive care admission and unscheduled returns with admission. We included 1878 ED and 1192 PC visits of which 855 (44.5%) and 534 (44.7%) occurred in the postintervention period, respectively. In the ED, salbutamol and epinephrine prescription rates fell from 13.8% (95% CI 11.8% to 16%) to 9.1% (95% CI 7.3% to 11.2%) (p<0.01) and 10.4% (95% CI 8.6% to 12.4%) to 9% (95% CI 7.2% to 11.1%) (n.s.), respectively. In PC, salbutamol, corticosteroid and antibiotic prescription rates fell from 38.3% (95% CI 34.6% to 42.0%) to 15.9% (95% CI 12.9% to 19.5%) (p<0.01), 12.9% (95% CI 10.5% to 15.7%) to 3.6% (95% CI 2.2% to 5.7%) (p<0.01) and 29.6% (95% CI 26.2% to 33.2%) to 9.5% (95% CI 7.2% to 12.5%) (p<0.01), respectively. No significant variations were noted in control measures. We safely decreased the use of unnecessary treatments for AB. Collaboration between PC and ED appears to be an important factor for success.

  • quality improvement
  • bronchiolitis
  • treatments
  • children
  • pediatric emergency department
  • primary care

http://dx.doi.org/10.1136/archdischild-2019-318085

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    Footnotes

    • Contributors MM conceptualised and designed the study, supervised data collection, analysed the data, wrote and critically revised the initial draft of the manuscript and approved the final manuscript as submitted. NP collaborated in the study design, wrote and critically revised the initial draft of the manuscript and approved the final manuscript as submitted. CS-H collaborated in the design of the study, participated in data collection and critically revised the manuscript. LM-I collaborated in the design of the study, analysed the data and critically revised the manuscript. SM collaborated in the design of the study, participated in data collection and critically revised the manuscript. JB conceptualised and designed the study, supervised data collection, analysed the data, wrote and critically revised the initial draft and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding Annual research grant from the Spanish Society of Pediatric Emergency Medicine in 2018.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Ethics Committee of the Basque Country.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.