WIP 142 - Quality improvement project to decrease the utilization of chest x-rays, respiratory viral swabs and albuterol in the management of bronchiolitis at a large urban safety net hospital in Brooklyn, NY

Poster Number: WIP 142
Publication Number: WIP 142.2547

Background: Bronchiolitis is a viral illness in patients under the age of 2, characterized by symptoms of rhinorrhea, cough, and respiratory distress. Based on current recommendations from the American Academy of Pediatrics, bronchiolitis is a clinical diagnosis, and it advocates for supportive care with suction, supplemental oxygen, and intravenous hydration when indicated.

Objective: To streamline the management of bronchiolitis in children under 2 years of age within 6 months using targeted interventions:
1) Reduce Chest X-rays from 21% to 10%
2) Reduce Respiratory Viral Swabs (RVS) from 90% to 50%
3) Reduce Albuterol usage from 38% to 20%

Design/Methods: A needs assessment was performed by analyzing electronic medical records (EMR) of discharged patients with bronchiolitis in the previous season (October 2022 –February 2023). Inclusion criteria: Children between 0-2 years of age, discharged with the diagnosis of bronchiolitis, from the pediatric emergency department (PED) or pediatric inpatient unit. Exclusion criteria: Patients admitted directly to the pediatric intensive care unit, with pre-existing chronic lung disease, sickle cell disease, primary or secondary immunodeficiency, or with a discharge diagnosis other than bronchiolitis.
A series of interventions using Plan Do Study Act (PDSA) was started from October 2023 at two-week intervals. The first intervention was 1:1 education on Bronchiolitis AAP guidelines to the PED and inpatient providers. The second intervention was displaying posters in the PED and the inpatient unit, which serves as a constant reminder for the providers. The third intervention was a mass email to providers, the proposed fourth intervention is an educational session at rounds, and the fifth will be a provider pledge. At the end of every PDSA cycle, the EMR will be analyzed for chest x-ray, RVS, and Albuterol usage. Student t-tests will be performed to determine the impact the previously stated interventions had on the management of bronchiolitis. The study has received IRB-exempt approval.