Pathway Background and Objectives

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 to infants with bronchiolitis
  • 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)
  • Decrease unnecessary continuous pulse oximetry use

Algorithm  Educational Module 

  • Percentage of eligible patients with pathway order set usage (inpatient)
  • Percentage of patients without CXR ordered (ED and inpatient)
  • Percentage of patients without viral testing, excluding influenza & COVID-19 (ED to discharge and ED to inpatient)
  • Percentage of patients without albuterol ordered (ED to discharge and ED to inpatient and during inpatient stay)
  • Percent all inpatients in > 2 doses albuterol (inpatient)
  • Average LOS ED (minutes), inpatient (days)
  • Percentage inpatients discharged who return to the ED
  • Percentage inpatients discharged who are readmitted
  • Pathway usage bundle: % without CXR during stay, % without viral testing (except flu/covid-19), % without receiving bronchodilator (ED and inpatient)
  • Ilana Waynik, MD
  • Eric Hoppa, MD

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.