A quality improvement intervention to reduce emergency department radiography for bronchiolitis

Reiter, Joel; Breuer, Adin; Breuer, Oded; Hashavya, Saar; Rekhtman, David; Kerem, Eitan; Cohen‐Cymberknoh, Malena

doi:10.1016/j.rmed.2018.02.014

Cited by 10 publications

(13 citation statements)

References 21 publications

(37 reference statements)

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“…2 A cohort study performed in Israel 8 points out that the thoracic X-ray is used for different respiratory emergencies, especially bronchiolitis, even if there is no recommendation for its use, according to the American Academy of Pediatrics (AAP). 8 A similar orientation was identified in the North-American analysis, 9 which does not advise the use of thoracic X-ray to treat acute exacerbation of asthma. 9 The analysis conducted in the Republic of Korea 10 stated there are many physicians using the X-ray in the screening of non-specific abdominal symptoms due to difficulties in diagnosis.…”

Section: Retrospective Study (N=23591084)mentioning

confidence: 74%

“…14 5th category -instruments used to reduce the exposure to ionizing agents in pediatric emergency patients Several instruments are used to guide health professionals as to the use of imaging examinations, in order to reduce the unnecessary exposure to ionizing agents in pediatric UE patients. 1,2,[7][8][9][10][11][12] The Alvarado Score is used for abdominal CT. 2 For head CT, the following instruments were reported: Pediatric Emergency Care Applied Research Network (PECARN), 1,2,7,12 National Emergency X-Radiography Utilization Study (NEXUS), 1,7 Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) 1 and Canadian Assessment of Tomography for Childhood Head Injury (CATCH). 1,7 The last two, however, were considered little reliable for clinical use due to their low sensitivity.…”

Section: Reviewmentioning

confidence: 99%

“…9 Among the analyzed articles, some implemented effective proposals to reduce the use of imaging examinations. In the cohort study, 8 an intervention that aims at limiting the use of thoracic X-ray to diagnose bronchiolitis and assess if pediatric UEs follow the current guidelines was implemented. Before intervention, the level of radiography was 44%, and then decreased to 36.6%.…”

Section: Th Category -Proposals Of Interventionmentioning

confidence: 99%

“…The authors suggested that similar interventions should be implemented in other pediatric UEs. 8 A study 11 analyzed the implementation of a policy whose purpose was to reduce the use of CT in patients with suspicion of peritonsillar abscess, recommending that professionals in the UEs request the evaluation of otolaryngologists before requiring imaging examinations in pediatric patients with unspecific physical examination. The efficacy of this policy was proven by observing a 13% reduction in the use of CT in the analyzed populations.…”

Section: Th Category -Proposals Of Interventionmentioning

confidence: 99%

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Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Floriani¹,

Borgmann²,

Barreto³

et al. 2022

Rev. paul. pediatr.

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Objective: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. Data sources: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. Data synthesis: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. Conclusions: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children’s exposure to ionizing agents.

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Section: Retrospective Study (N=23591084)mentioning

confidence: 74%

Section: Reviewmentioning

confidence: 99%

Section: Th Category -Proposals Of Interventionmentioning

confidence: 99%

Section: Th Category -Proposals Of Interventionmentioning

confidence: 99%

See 2 more Smart Citations

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Floriani¹,

Borgmann²,

Barreto³

et al. 2022

Rev. paul. pediatr.

View full text Add to dashboard Cite

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“…Moreover, there is no quick fix as no type of implementation has shown to be the most effective. 24 Nonetheless, more active approaches to guideline implementation such as educational meetings and outreach, 25 and audit and feedback 26 may give approximately 20% reduction passive approaches such as postal dissemination where the effect range from none 27,28 up to 10% difference between intervention and control group. 29…”

Section: Discussionmentioning

confidence: 99%

Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period

Gransjøen

Thorsen

Lysdahl

et al. 2021

Acta Radiologica Open

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Background An ever-increasing technological development in the field of radiology urges a need for guidelines to provide predictable and just health services. A musculoskeletal guideline was developed in Norway in 2014, without active implementation. Purpose To investigate the impact of active guideline implementation on the use of musculoskeletal diagnostic imaging most frequently encountered in general practice (pain in the neck, shoulders, lower back, and knees). Material and Methods The total number of outpatient radiological examinations across modalities registered at the Norwegian Health Economics Administration between January 2013 and February 2019 was assessed using an interrupted time series design. Results A 12% reduction in the total examination of Magnetic Resonance Imaging shoulder and knee, and x-ray lower back and shoulder was found at a significant level ( p = 0.05). Stratified analysis (Magnetic Resonance Imaging examination as one group and x-ray examinations as the other) showed that this reduction mainly was due to the reduction in the use of Magnetic Resonance Imaging examinations (shoulder and knee) which was reduced by 24% at a significant level ( p = 0.002), while x-ray examinations had no significant level change ( p = 0.71). No other statistically significant changes were found. Conclusion The impact of the implementation on the use of imaging of the neck, shoulder, lower back, and knee is uncertain. Significant reductions were demonstrated in the use of some examinations in the intervention county, but similar effects were not seen when including a control group in the analysis. This indicates a diffusion of the implementation, or other interventions or events that affected both counties and occurred in the intervention period.

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The Long-Term Effect of a Quality Improvement Intervention in the Management of Bronchiolitis

et al. 2020

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A quality improvement intervention to reduce emergency department radiography for bronchiolitis

Abstract: This key intervention was successful in reinforcing the AAP guidelines, promoting greater cost-effectiveness, reducing radiation exposure, and saving valuable time and resources for the ED staff and the hospital.

Cited by 10 publications

References 21 publications

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period

The Long-Term Effect of a Quality Improvement Intervention in the Management of Bronchiolitis

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