Management of acute bronchiolitis: can evidence based guidelines alter clinical practice?

Barben, Jürg; Kuehni, CE; Trachsel, Daniel; Hammer, Jürg

doi:10.1136/thx.2007.094706

Cited by 69 publications

(77 citation statements)

References 36 publications

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“…However, most of these studies were in the inpatient setting, with the extent of reduction in CXRs, viral testing, and bronchodilator use widely varying between studies. 17,[25][26][27][28][29][30] Furthermore, studies on the cost impact of bronchiolitis guidelines have been mixed and mostly in the inpatient setting. 25,26,29 To our knowledge, no previous study has quantified the cost impact of a bronchiolitis guideline in an ED.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS:We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196 409 (95% CI: $135 592 to $258 223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED. Pediatrics 2014;133:e227-e234 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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“…27,28 In Switzerland, evidence-based guidelines for bronchiolitis demonstrated a national impact on care measured by pediatrician self-reported medication use. 29 Guidelines were published and disseminated by the national pediatric society. 29 However, the relatively small…”

Section: Discussionmentioning

confidence: 99%

“…29 Guidelines were published and disseminated by the national pediatric society. 29 However, the relatively small…”

Section: Discussionmentioning

confidence: 99%

Management of Bronchiolitis in the Emergency Department: Impact of Evidence-Based Guidelines?

et al. 2013

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OBJECTIVE: Recent practice guidelines from the American Academy of Pediatrics recommend limiting use of bronchodilators, corticosteroids, antibiotics, and diagnostic testing for patients with bronchiolitis. We sought to determine the association of the evidence-based guidelines with bronchiolitis care in the emergency department (ED). METHODS:We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED visits. We compared utilization for patient visits before and after the publication of the guidelines. We used logistic regression to determine the association of the availability of the guidelines with resource utilization.RESULTS: Bronchodilators were used in 53.8% of patient visits with no differences noted after the introduction of the guidelines (53.6% vs 54.2%, P = .91). Systemic steroids were used in 20.4% of patient visits, and antibiotics were given in 33.2% of visits. There were no changes in the frequency of corticosteroid (21.9% vs 17.8%, P = .31) or antibiotic (33.6% vs 29.7%, P = .51) use. There was an associated decrease in use of chest x-rays (65.3% vs 48.6%, P = .005). This association remained significant after adjusting for patient and hospital characteristics with an adjusted odds ratio of 0.41 (95% confidence interval 0.26-0.67).CONCLUSIONS: For patients seen in the ED with bronchiolitis, utilization of diagnostic imaging has decreased with the availability of the American Academy of Pediatrics practice guidelines. However, there has not been an associated decrease in use of nonrecommended therapies. Targeted efforts will likely be required to change practice significantly.

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“…Daily costs of antibiotic therapy for inpatient stays were estimated based on typical daily dosage multiplied by the wholesale acquisition cost of each drug. Typical dosages and mix of expected therapy were derived from published clinical treatment guidelines [65][66][67][68][69][70][71][72][73][74][75]. Guidelines outline multiple treatment options and patients may require more than one antibiotic administered concurrently.…”

Section: Methodsmentioning

confidence: 99%

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

Schuetz

Balk

Briel³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment. Methods: To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact

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Management of acute bronchiolitis: can evidence based guidelines alter clinical practice?

Abstract: ABSTRACT

Cited by 69 publications

References 36 publications

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Management of Bronchiolitis in the Emergency Department: Impact of Evidence-Based Guidelines?

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

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