Summary

A Clinical Practice Improvement study was conducted at 10 pediatric hospitals throughout the US to determine areas of significant improvement in the treatment of pediatric bronchiolitis/RSV patients. The analyses in this study formed the basis for the development of research-based dynamic protocols that identify process steps associated with better outcomes for pediatric bronchiolitis/RSV patients. Data were collected on 804 bronchiolitis/RSV patients.

Primary Objective

Determine areas of significant improvement in the treatment of pediatric bronchiolitis/RSV patients.

Methods

Data were collected on 804 pediatric bronchiolitis/RSV patients. Multivariate analyses were performed on all data.

Results

1.      After controlling for age, gender, severity of illness, and existing heart disease, longer length of stay was associated with chest physiotherapy, intubation, Ipratropium bromide, Lasix, steroids, and continuously nebulized Beta agonists.

2.      After controlling for age, gender, severity of illness, and existing heart disease, higher costs were associated with all of the treatment variables in number 1 above, as well as use of arterial lines, use of central lines, lumbar punctures, and admission to a pediatric intensive care unit.

Impact

Extensive variation in practice was found across all 10 pediatric hospitals, regardless of severity of illness.  If the best practices were used in all our study institutions we would expect on average a 2.0 day decrease in length of stay and a $4,982 decrease in cost per case.