Bronchiolitis Clinical Pathway Pathway Background and Objective Bronchiolitis, a viral infection of the lower respiratory tract that primarily affects infants ages 0-24 months, is the most frequent cause of hospital admission for children under 1 year of age, accounting for upwards of 18% of all hospitalizations in the United States. At ~150,000 admissions per year, it is the most common cause of hospital admission during the first year of life, with an approximated annual cost of ~$1.73 billion dollars nationally. In 2014, the AAP published updated guidelines on the diagnostic work up, treatment, and prevention of bronchiolitis. Previously there had been variation in practice amongst providers, and little evidence to support certain commonly used modalities of diagnosis and treatment. The objectives of this pathway are to: Standardize delivery of evidence based care based on recent AAP best practice guidelines Avoid routine use of therapies and testing that have been shown to have little clinical benefit (i.e. routine viral testing, chest x-rays, antibiotic use, steroids, bronchodilators) Maximize the usage of enteral hydration when appropriate (by mouth and/or nasogastric tubes) Increase screening for 2nd and 3rd hand smoke exposure Decrease unnecessary continuous pulse oximetry use Algorithm Download Bronchiolitis Algorithm Quality Metrics Percentage of eligible patients treated per pathway by order set usage Percentage of patients without CXR ordered (ED and inpatient separately) Percentage of patients without viral testing ordered in ED (excluding influenza) Percentage of patients without albuterol ordered (ED and inpatient separately) Total number of bronchodilator doses used in the ED and/or inpatient settings Percentage of patients with inpatient discharge summary sent to PCP with evidence based bronchiolitis management/AAP Bronchiolitis clinical guideline Average LOS ED (minutes), inpatient (days) Educational Module Download Bronchiolitis Educational Module Key References Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-e502. Society of Hospital Medicine – Pediatric Hospital Medicine: Five Things Physicians and Patients Should Question. Choosing Wisely, An initiative of the ABIM Foundation, 2013. Pathway Contacts Ilana Waynik, MD Eric Hoppa, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
