Knowledge translation in Western Australia tertiary paediatric emergency department: An audit cycle of effectiveness of guideline dissemination on bronchiolitis management

Abstract

Aim Bronchiolitis is the commonest cause of hospitalisation for infants. Evidence‐based Australasian bronchiolitis guideline was developed and introduced in 2017. This audit was to determine if the knowledge translation process of the updated local tertiary hospital bronchiolitis guideline (based on the Australasian guideline) reduced unnecessary interventions. Methods A retrospective chart review of infants with bronchiolitis diagnosis during the pre‐guideline (1 July to 31 August 2015) and post‐guideline (1 July to 31 August 2017) period, with the primary outcome of the number/proportion of unnecessary interventions. Results Presentations between 1 July to 31 August 2015 (n = 465) were compared with 2017 (n = 343). There was no difference in undertaking chest X‐ray (24 (5.2%) vs. 17 (5.0%), odds ratio (OR) 0.98 (95% confidence interval (CI) 0.71–1.35), P = 0.911), salbutamol (23 (4.9%) vs. 10 (2.9%), OR 0.86 (95% CI 0.65–1.13), P = 0.279), glucocorticoids (2 (0.4%) vs. 5 (1.5%), OR 1.89 (95% CI 0.83–4.31), p = 0.129), antibiotics (11 (2.4%) vs. 5 (1.5%), OR 0.86 (95% CI 0.65–1.15), P = 0.307) or nasopharyngeal aspirate (172 (37%) vs. 124 (36.2%), OR 1.00 (95% CI 0.87–1.67), P = 0.937) in hospital. Adrenaline was not administered in both years. There was reduced hospital admissions (303 (65.2%) vs. 192 (56.0%), OR 0.82 (95% CI 0.71–0.95), P = 0.008) with no difference in paediatric intensive care unit admissions (10 (2.2%) vs. 8 (2.3%), OR 1.04 (95% CI 0.65–1.67), P = 0.863). Conclusion The dissemination process of the updated local hospital bronchiolitis guideline did not show any statistically significant reduction of unnecessary interventions in the hospital. Further studies are required to determine the effective process to instigate changes in health services.

Interventions to reduce acute paediatric hospital admissions: a systematic review

“…Of the seven papers included in the previous review, two were included in the present review 15,30 , three were published prior to 2000, one was published French and one did not meet inclusion criteria. Nineteen studies 9,10, 16,17,21,23,24,26,27,[31][32][33][34][35][36][37][38][39][40] were published after the search in the previous review. 11…”

“…Thirteen studies were from North America, 16,17,23,24,26,[28][29][30][34][35][36][37]39 eight from Europe, 9,10,15,21,22,31,32,38 six from Australia, 18,20,25,27,40,41 and one from Asia. 33 Nineteen studies had a before-and-after design and four 22,32,33,35 compared non-randomised assessment options within the same period.…”

“…The earliest studies began in 18,29 and the latest in 2017; 36 seven studies began between 1990-1999, 15,18,25,29,30 ten between 2000-2009 10,16,17,[22][23][24]28,31,35,38 and eleven after 2009. 9, 21,26,27,[32][33][34]36,37,39,40…”

“…Hospital admission was reported in studies, 9,10,15,16,[18][19][20]22,23,[25][26][27][28][29][30][31][32][34][35][36][38][39][40] readmission in nine, 17,[19][20][21]24,26,39 and length of stay in 15 studies. 10,16,[18][19][20][21]23,24,[26][27][28][29][30]36,37 The primary outcome was presented as odds ratio (OR) or relative risk (RR) of hospital admission [15][16][17]22,32,34,35...…”

“…Quality appraisal categorised 14 studies as high 9,17,20,23,[26][27][28][29]31,34,[36][37][38][39] , ten moderate 10,15,16,19,21,24,25,30,33,40 , and four as low 18,22,32,35 quality (Table 2). Reasons for a low categorisation included no information on follow-up period, short follow-up period, inadequately addressed confounding factors, selection bias and lack of generalisability of study results.…”