Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Knapp, Jane F.; Simon, Stephen D.; Sharma, Vidya

doi:10.1542/peds.2012-2830

Cited by 51 publications

(64 citation statements)

References 31 publications

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“…Chest radiography is described in the literature as overused and demonstrated to only rarely contribute to management in this disease. 8,12 Cost and exposure to radiation are the primary consequences of overuse of chest radiography. Each of these therapies or tests is explicitly not recommended in the AAP guideline.…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…[3][4][5][6][7] Nevertheless, overuse of ineffective therapy remains common in bronchiolitis, with overuse of b-agonists, corticosteroids, antibiotics, viral testing, and chest radiography all well documented. [8][9][10][11] In response to the problem, many hospitals have adopted quality improvement (QI) strategies, such as implementing clinical practice guidelines, intended to standardize the approach to bronchiolitis or to operationalize recommendations made in national evidence-based guidelines. [12][13][14][15] There are a wide range of published approaches and outcomes, and it remains unclear which strategies are superior.…”

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confidence: 99%

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Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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BACKGROUND: Bronchiolitis causes nearly 20% of all acute care hospitalizations for young children in the United States. Unnecessary testing and medication for infants with bronchiolitis contribute to cost without improving outcomes. OBJECTIVES:The goal of this study was to systematically review the quality improvement (QI) literature on inpatient bronchiolitis and to propose benchmarks for reducing unnecessary care. METHODS:Assisted by a medical librarian, we searched Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. Studies describing any active QI intervention versus usual care in hospitalized children ,2 years of age were included. Data were extracted and confirmed by multiple investigators and pooled by using a random effects model. Benchmarks were calculated by using achievable benchmarks of care methods. RESULTS:Fourteen studies involving .12 000 infants were reviewed. QI interventions resulted in 16 fewer patients exposed to repeated doses of bronchodilators per 100 hospitalized (7 studies) (risk difference: 0.16 [95% confidence interval: 0.11-0.21]) and resulted in 5.3 fewer doses of bronchodilator given per patient (95% confidence interval: 2

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Section: Secondary Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

et al. 2014

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“…No therapy has proven particularly useful, and evidence for overuse of unnecessary therapy is widely available. [1][2][3][4][5][6][7][8][9] In response, the American Academy of Pediatrics (AAP) published a clinical practice guideline with the intention to improve the care of bronchiolitis. 10,11 Furthermore, many institutions have published their own experience in reducing unnecessary care by using local guidelines and other quality improvement (QI) methods.…”

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confidence: 99%

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

et al. 2016

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Dr Ralston conceptualized the project and codirected its implementation, coordinated and critically reviewed all analyses, and drafted the initial manuscript; Dr Garber conceptualized the project and codirected its implementation and critically reviewed and revised the manuscript; Ms Rice-Conboy coordinated all aspects of project design, implementation, and data collection and critically reviewed and revised the manuscript; Drs Mussman, Shadman, and Walley provided project leadership and content, performed a portion of the analysis, and critically reviewed and revised the manuscript; Ms Nichols performed the analyses, prepared all tables and fi gures, and critically reviewed the manuscript; and all authors approved the fi nal manuscript as submitted.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Excessive use of resources in health care has not been found to improve quality or outcomes, but it does affect cost. 11,[13][14][15][16] The recent Choosing Wisely initiative encourages every specialty to consider reducing use of tests and procedures that are often unnecessary and sometimes can be harmful. 17 Traditional ED quality measures have included measures of timeliness such a Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; b as length of stay, time to antibiotics, boarder time, safety measures such as errors, hand-washing, and measures of patient-centeredness such as leftwithout-being-seen rates and patient satisfaction.…”

mentioning

confidence: 99%

Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency

et al. 2015

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BACKGROUND AND OBJECTIVES: Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency. METHODS:We evaluated condition-specific resource use (laboratory tests; imaging; antibiotics, intravenous fluids, and ondansetron; admission) by physicians at 2 tertiary pediatric EDs for 4 common conditions (fever, head injury, respiratory illness, gastroenteritis). Resources used, ED length of stay (efficiency measure), and 72-hour return to ED (return rate [RR]) (balancing measure) were reported on scorecards with boxplots showing physicians their practice relative to peers. Quarterly scorecards were distributed for baseline (preintervention, July 2009-August 2010) and postintervention (September 2010-December 2011). Preintervention, postintervention, and trend analyses were performed. RESULTS:In 51 450 patient visits (24 834 preintervention, 26 616 postintervention) seen by 96 physicians, we observed reduced postintervention use of abdominal and pelvic and head computed tomography scans, chest radiographs, intravenous antibiotics, and ondansetron (P , .01 for all). Hospital admissions decreased from 7.4% to 6.7% (P = .002), length of stay from 112 to 108 minutes (P , .001), and RR from 2.2% to 2.0%. Trends for use of laboratory tests and intravenous antibiotics showed significant reduction (P , .001 and P , .05, respectively); admission trends increased, and trends for use of computed tomography scans and plain abdominal radiographs showed no change.CONCLUSIONS: Physician feedback on practice patterns relative to peers results in reduction in resource use for several common ED conditions without adversely affecting ED efficiency or quality of care.There has been considerable focus on overall resource use and cost of care in our nation's emergency departments (EDs), particularly for nonemergent conditions that often make up a large share of the case mix in the typical ED. Additionally, wide variation in practice and resource use that cannot be explained by patient-related factors has been demonstrated in both adults and children, including emergency medicine patients. [1][2][3][4][5][6][7][8][9][10][11][12] Excessive use of resources in health care has not been found to improve quality or outcomes, but it does affect cost. 11,[13][14][15][16] The recent Choosing Wisely initiative encourages every specialty to consider reducing use of tests and procedures that are often unnecessary and sometimes can be harmful. 17 Traditional ED quality measures have included measures of timeliness such

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Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children

Cited by 51 publications

References 31 publications

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

Effectiveness of Quality Improvement in Hospitalization for Bronchiolitis: A Systematic Review

A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis

Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency

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