Use of a Clinical Pathway to Improve Bronchiolitis Care for Children in a Community Hospital

Bronchiolitis is the most common cause of hospitalization among infants. There are limited proven effective therapies for bronchiolitis and the mainstay of management is supportive care. International pediatric academic organizations have published bronchiolitis clinical practice guidelines (BCPGs) but wide variability in bronchiolitis management persists. The purpose of this project was to improve bronchiolitis care in a community hospital where bronchiolitis care variability has led to increased ED length of stay (LOS), increased hospitalizations, and transfers for intensive care. A bronchiolitis clinical pathway (BCP) based on the American Academy of Pediatrics’ 2014 BCPG was created. The project’s goals were to increase BCP utilization; to decrease use of continuous pulse oximetry, chest x-rays and albuterol; and to decrease ED LOS while maintaining or decreasing 72-hour bronchiolitis ED return rate and ED left without being seen rate. The BCP was applied to children one month to two years of age presenting to the community hospital’s ED during the 2019-2020 bronchiolitis season. The Institute of Healthcare Improvement’s Plan-Do-Study-Act cycles were the project’s model of improvement. One hundred ninety-six patients were enrolled with a mean age of ten months. Forty-three per cent were discharged, 38% admitted, and 19% transferred. Run charts showed that targets were met and improvements were sustained in the goals of increasing BCP use and decreasing continuous pulse oximetry. Targets were met but the improvements were not sustained in chest x-ray and albuterol use, and ED LOS. There was no difference in the ED 72-hour return rate for bronchiolitis or LWBS rate between the project period and the previous season. BCP implementation led to decreased resource utilization with no adverse effects in the ED bronchiolitis 72-hr return rate and the ED LWBS rate