Pediatric Bronchiolitis Quality Improvement

NCT03528083 | Completed

• 1 other identifier: 1219188
• Study Type: interventional
• Target: 1,321
• Locations: 1 country
• Sites: 1

Brief Summary

Bronchiolitis is a respiratory illness characterized by acute inflammation of the airways, typically caused by a virus. By definition, it impacts children between 2 months and 2 years of age and is the most common cause of hospitalization among infants in the first year of life (American Academy of Pediatrics). Children with this illness may exhibit respiratory distress, as well as symptoms of viral respiratory illness, such as sneezing, nasal congestion, and cough. Often, hospitalization is required for respiratory distress and to support hydration needs. Evidence based guidelines for the treatment of acute viral bronchiolitis primarily involve supportive care, which most often includes supplemental oxygen, hydration, and suctioning of secretions. However, in practice, bronchiolitis care is highly variable, often involving therapies such as inhaled bronchodilators, systemic corticosteroids, inhaled hypertonic saline, continuous pulse oximetry, chest physiotherapy, antibacterial medications, and use of intravenous fluids, all of which have been shown to be unnecessary and costly. Unnecessary care remains although multiple published quality improvement studies centered on acute bronchiolitis have proven successful. Quality improvement interventions have shown reduced use of unnecessary treatments and reduced resource allocation. Therefore, the investigators will conduct a quality improvement process to improve adherence to bronchiolitis treatment guidelines for children with bronchiolitis treated at University of California Davis Children's Hospital.

Conditions

Bronchiolitis

Keywords

Bronchiolitis; Children; Hospital

Outcome Measures

Primary Outcomes (9)

• Chest x-ray utilization

  Percentage of patients meeting inclusion criteria who received a chest x-ray

  Through study completion, an average of 19 months

• Antibiotic utilization

  Percentage of patients meeting inclusion criteria who received antibiotics

  Through study completion, an average of 19 months

• Bronchodilator utilization

  Percentage of patients meeting inclusion criteria who received bronchodilators

  Through study completion, an average of 19 months

• Steroid utilization

  Percentage of patients meeting inclusion criteria who received steroids

  Through study completion, an average of 19 months

• Hypertonic saline utilization

  Percentage of patients meeting inclusion criteria who received nebulized hypertonic saline.

  Through study completion, an average of 19 months

• Chest physiotherapy utilization

  Percentage of patients meeting inclusion criteria who received chest physiotherapy

  Through study completion, an average of 19 months

• Intravenous fluid utilization

  Percentage of patients meeting inclusion criteria who received intravenous fluid

  Through study completion, an average of 19 months

• Continuous pulse oximetry utilization

  Percentage of patients meeting inclusion criteria who received continuous pulse oximetry

  Through study completion, an average of 19 months

• Supplemental oxygen utilization

  Percentage of patients meeting inclusion criteria who received supplemental oxygen

  Through study completion, an average of 19 months

Secondary Outcomes (8)

• Length of stay index

  Through study completion, an average of 19 months

• Readmission rate

  Within 30 days following the index hospitalization discharge date

• Emergency room revisit rate

  Within 30 days following the index hospitalization discharge date

• Bronchiolitis specific discharge instructions

  Through study completion, an average of 19 months

• Timely completion of discharge summary

  Within 48 hours of discharge from the index hospitalization

Study Arms (2)

Retrospective Controls

NO INTERVENTION

A retrospective control group of patients with a diagnosis of bronchiolitis and meeting inclusion criteria will be used as a comparison group. These patients received usual care for bronchiolitis at our institution.

Quality Improvement

EXPERIMENTAL

All patients diagnosed with bronchiolitis and meeting inclusion criteria will undergo the intervention of a bronchiolitis quality improvement process to improve bronchiolitis care quality at our institution.

Other: Bronchiolitis quality improvement

Interventions

Bronchiolitis quality improvement OTHER

Patients in the intervention group will undergo a quality improvement process to improve care quality for bronchiolitis at our hospital.

Quality Improvement

Eligibility Criteria

• Age: 1 Day - 2 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children less than 2 years of age admitted to UC Davis Children's Hospital with any diagnosis of bronchiolitis

You may not qualify if:

• Children or adults greater than 2 years of age
• Children born at less than 35 weeks gestational age
• Children with underlying illnesses, such as chronic lung disease, congenital heart disease, other congenital anomalies including airway anomalies, or immunodeficiencies

Sponsors & Collaborators

• University of California, Davis: lead

Study Sites (1)

UC David Medical Center

Sacramento, California, 95817, United States

Location

MeSH Terms

Conditions

Bronchiolitis

Condition Hierarchy (Ancestors)

Bronchitis; Respiratory Tract Infections; Infections; Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases

Study Officials

• Michelle Hamline, MD, PhD

  University of California, Davis

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The investigators will conduct a quality improvement process for all children diagnosed with bronchiolitis at our hospital who meet inclusion criteria. Outcomes for these patients will be compared with retrospective controls.

Study Record Dates

• First Submitted: April 9, 2018
• First Posted: May 17, 2018
• Study Start: May 31, 2018
• Primary Completion: May 30, 2020
• Study Completion: December 31, 2021
• Last Updated: May 16, 2022

Record last verified: 2022-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)