98. IMPROVING BRONCHIOLITIS MANAGEMENT WITH A CARE PATH

Abstract

Background Bronchiolitis is the number one cause of hospitalization in children under 2 years of age. AAP guidelines emphasize that only supportive care is needed for bronchiolitis. Data obtained from our institution showed poor adherence to AAP guidelines. This project was undertaken with the goal of improving compliance with these guidelines. Aim Statement Our aim was to reduce length of stay (LOS) for admitted low risk patients with bronchiolitis, age 1-24 months, from 67 hours to Interventions A care path and respiratory score were adapted for our institution. Every patient admitted for bronchiolitis was assessed and given a score using respiratory rate, auscultation, and use of accessory muscles. All patients was ordered nasal suction, saline and reassessed. Persistently high scores resulted in escalation of care. The respiratory score and order set were built into the EMR. The care path was made hospital policy. Physicians, respiratory and nursing received education. Measures Data from patients age 1-24 months hospitalized with bronchiolitis from Nov - Dec 2017 were obtained. Excluded were those born Results Charts of patients with bronchiolitis from Jan to Dec 2018 were reviewed. Data were collected regarding LOS, PICU use, and use of chest x ray, albuterol, steroids, epinephrine and antibiotics. We saw an increase in cases in Sept-Dec 2018 with no increase in PICU use. Nov and Dec 2018 average LOS was Conclusions and Next Steps Conclusions and Next Steps With additional education and reinforcement, we hope to make the trend toward improved care for bronchiolitis the standard in our institution. Early observations after implementation of the care path indicate a reduced length of stay, but further data points are needed to know if this change will be sustained.