|[March 28, 2014]
Journal Report Reveals Benefits of Implementing Clinical Practice Guidelines at Children's Medical Center
DALLAS --(Business Wire)--
Bronchiolitis, the number-one cause of infant hospitalizations
nationally, was the focus of a multidisciplinary effort by physicians
and clinicians at Children's Medical Center Dallas to establish and
implement clinical practice guidelines (CPGs) aimed at streamlining care
and reducing unnecessary tests and therapies. Results of the successful
initiative, including two seasons of post-implementation data, were
published in the March issue of Pediatrics, the journal of the
American Academy of Pediatrics (AAP). Among the findings were a
reduction in the use of chest X-rays, bronchodilators, steroids and
antibiotics, along with shorter hospital stays.
Hospitalizations for bronchiolitis, a common respiratory infection
affecting children under the age of two, are estimated to cost more than
$500 million annually in the United States. Most cases are caused by the
highly contagious respiratory syncytial virus (RSV), although influenza
and other viruses can also cause bronchiolitis, which is far more
prevalent in winter months. The vast majority of infants and toddlers
recover at home with supportive care, but each year bronchiolitis is
responsible for well over 100,000 hospital admissions nationally.
Although complicating illnesses and prematurity can be contributing
factors, otherwise healthy babies can sometimes develop severe
respiratory distress as a result of this infection.
"There is a wide variation in management of bronchiolitis across the
country, and even within individual hospitals, particularly in the
utilization of certain tests and treatments," said Dr. Vineeta Mittal, a
pediatric hospitalist at Children's and associate professor of
pediatrics at the University of Texas Southwestern Medical Center.
"Evidence- and consensus-based guidelines can be a powerful tool to
reduce variation, help providers deliver disease-specific best
practices, and achieve efficient resourceutilization. However,
implementing CPGs is complex and requires a multifaceted approach," said
Dr. Mittal, who headed the task force that developed, implemented and
evaluated the bronchiolitis initiative.
A multidisciplinary team of key stakeholders at Children's came together
in 2010 to develop the guidelines, including nurses, respiratory
therapists, emergency department physicians, general pediatricians,
hospitalists and sub-specialists in infectious disease, pulmonology and
critical care medicine. Implementation of the guidelines included
provider education, online resources including electronic order sets,
objective measures such as a bronchiolitis scoring tool and ongoing
communications and feedback. Results were evaluated by compiling data on
hospitalized children from birth to two years of age with no underlying
condition, comparing two years of post-implementation bronchiolitis
seasons-September through April-with the prior pre-implementation season.
Chest X-rays were reduced from 59.7 to 45.1 percent in the first season
and 39 percent in the second season, indicating a sustained downward
trend. Bronchodilator utilization decreased from 27 to 20 percent in
season one and 14 percent in season two. Length of stay was reduced from
2.3 to 1.8 days with no significant change in readmission rates.
"Our data show that we can effectively and significantly reduce resource
utilization without compromising care for one of the most common
childhood diseases that requires hospitalization," said Dr. Jeffrey
Kahn, professor and director, division of infectious disease at
Children's and UT Southwestern Medical Center. Dr. Kahn is a member of
bronchiolitis task force and the senior author of the journal article.
As health care adapts from volume-based care to value-based care, the
bronchiolitis initiative at Children's shows that implementing
evidence-based practice guidelines is effective and can streamline care.
"This study reports the financial benefits of a bronchiolitis guideline
achieved by avoiding tests and therapy not supported by current clinical
evidence. It will be of particular interest to those committed to both
reducing the financial burden of this common cause of hospitalization in
very young children and providing a high standard of care," said Sandra
McDermott, senior director of transport at Children's and member of the
bronchiolitis task force.
The abstract and full report in Pediatrics, "Inpatient
Bronchiolitis Guideline Implementation and Resource Utilization," can be
accessed by subscribers or purchased from the AAP website at http://pediatrics.aappublications.org/content/133/3/e730.full.pdf+html.
About Children's Medical Center
Founded in 1913, the not-for-profit Children's Medical Center is the
seventh-largest pediatric health care provider in the country, receiving
nearly 700,000 patient visits annually with 591 licensed beds at its two
full-service campuses in Dallas and Plano, multiple specialty clinics
and 16 primary care MyChildren's locations. Children's was first
pediatric hospital in Texas to achieve Level 1 Trauma status and is the
primary pediatric facility affiliated with UT Southwestern Medical
Center. For more than 100 years, Children's has been committed to making
life better for children. To learn more, please visit childrens.com.
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