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Completed

NCT Number: NCT03528083

Pediatric Bronchiolitis Quality Improvement

Bronchiolitis is a respiratory illness characterized by acute inflammation of the airways, typically caused by a virus. By definition, it impacts children between 2 months and 2 years of age and is the most common cause of hospitalization among infants in the first year of life (American Academy of Pediatrics). Children with this illness may exhibit respiratory distress, as well as symptoms of viral respiratory illness, such as sneezing, nasal congestion, and cough. Often, hospitalization is required for respiratory distress and to support hydration needs.

Evidence based guidelines for the treatment of acute viral bronchiolitis primarily involve supportive care, which most often includes supplemental oxygen, hydration, and suctioning of secretions. However, in practice, bronchiolitis care is highly variable, often involving therapies such as inhaled bronchodilators, systemic corticosteroids, inhaled hypertonic saline, continuous pulse oximetry, chest physiotherapy, antibacterial medications, and use of intravenous fluids, all of which have been shown to be unnecessary and costly. Unnecessary care remains although multiple published quality improvement studies centered on acute bronchiolitis have proven successful. Quality improvement interventions have shown reduced use of unnecessary treatments and reduced resource allocation. Therefore, the investigators will conduct a quality improvement process to improve adherence to bronchiolitis treatment guidelines for children with bronchiolitis treated at University of California Davis Children's Hospital.

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Key information

Conditions

Bronchiolitis Bronchial Diseases Bronchitis Infections Lung Diseases Lung Diseases, Obstructive Respiratory Tract Diseases Respiratory Tract Infections

Age range

1 day–2 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

UC David Medical Center

Sacramento, California, 95817, United States

About this study

A multidisciplinary team, involving pediatric hospitalists, pediatric emergency physicians, residents, medical students, nurses and nurse managers, and respiratory therapists will be assembled. The investigators will participate in a value stream mapping process, to map out the current pediatric bronchiolitis care process and identify areas for improvement in efficiency and effectiveness. The investigators will then begin the iterative process of implementing improvements to the bronchiolitis care process. Interventions will be evidence-based and designed to improve compliance with bronchiolitis care guidelines, as set forth by the American Academy of Pediatrics. Examples of possible interventions may include creation of a bronchiolitis admission order set, implementation of an evidence-based bronchiolitis clinical pathway, and/or institution of standardized bronchiolitis discharge criteria. Interventions will be implemented in a stepwise fashion, utilizing successive plan-do-study-act cycles, with a minimum 2 month period between interventions to monitor outcomes. The investigators will track utilization of diagnostic testing and treatments within our intervention group, as compared to historical controls who also meet inclusion criteria.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Children less than 2 years of age admitted to UC Davis Children's Hospital with any diagnosis of bronchiolitis

Exclusion criteria

  • Children or adults greater than 2 years of age
  • Children born at less than 35 weeks gestational age
  • Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies

Treatment and study plan

Bronchiolitis quality improvement

Other

Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.

Primary outcomes

  1. Chest x-ray utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received a chest x-ray

  2. Antibiotic utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received antibiotics

  3. Bronchodilator utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received bronchodilators

  4. Steroid utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received steroids

  5. Hypertonic saline utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received nebulized hypertonic saline.

  6. Chest physiotherapy utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received chest physiotherapy

  7. Intravenous fluid utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received intravenous fluid

  8. Continuous pulse oximetry utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received continuous pulse oximetry

  9. Supplemental oxygen utilization

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received supplemental oxygen

Secondary outcomes

  1. Length of stay index

    Time frame: Through study completion, an average of 19 months

    A ratio of observed to expected length of stay for patients admitted with bronchiolitis, as compared to national standards

  2. Readmission rate

    Time frame: Within 30 days following the index hospitalization discharge date

    Same hospital readmission rate for patients with a diagnosis of bronchiolitis

  3. Emergency room revisit rate

    Time frame: Within 30 days following the index hospitalization discharge date

    Same hospital emergency room revisit rate for patients with a diagnosis of bronchiolitis

  4. Bronchiolitis specific discharge instructions

    Time frame: Through study completion, an average of 19 months

    Percentage of patients meeting inclusion criteria who received bronchiolitis specific handout containing care instructions on discharge

  5. Timely completion of discharge summary

    Time frame: Within 48 hours of discharge from the index hospitalization

    Percentage of patients meeting inclusion criteria who had a discharge summary completed

  6. Timely routing of discharge summary

    Time frame: Within 48 hours of discharge from the index hospitalization

    Percentage of patients meeting inclusion criteria who had a discharge summary routed to their primary care provider

  7. CC capture rate

    Time frame: Through study completion, an average of 19 months

    The capture rate for comorbid conditions within our charting for patients diagnosed with bronchiolitis

  8. MCC capture rate

    Time frame: Through study completion, an average of 19 months

    The capture rate for major comorbid conditions within our charting for patients diagnosed with bronchiolitis

Sponsors and collaborators

Lead sponsor

University of California, Davis

Other

Registry information

Official study title

Pediatric Bronchiolitis Quality Improvement to Reduce Unnecessary Use of Diagnostic Testing and Treatment

Important dates

Study start
2018
Primary completion
2020
Study completion
2021
First posted
May 17, 2018
Registry last updated
May 16, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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