BACKGROUND: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. METHODS: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. RESULTS: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27-1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). CONCLUSIONS: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.
BACKGROUND: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. METHODS: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. RESULTS: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27-1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). CONCLUSIONS: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.
Authors: Shawn L Ralston; Allan S Lieberthal; H Cody Meissner; Brian K Alverson; Jill E Baley; Anne M Gadomski; David W Johnson; Michael J Light; Nizar F Maraqa; Eneida A Mendonca; Kieran J Phelan; Joseph J Zorc; Danette Stanko-Lopp; Mark A Brown; Ian Nathanson; Elizabeth Rosenblum; Stephen Sayles; Sinsi Hernandez-Cancio Journal: Pediatrics Date: 2014-11 Impact factor: 7.124
Authors: Charles G Macias; Jonathan M Mansbach; Erin S Fisher; Mark Riederer; Pedro A Piedra; Ashley F Sullivan; Janice A Espinola; Carlos A Camargo Journal: Acad Pediatr Date: 2014-11-08 Impact factor: 3.107
Authors: Eugenio Baraldi; Marcello Lanari; Paolo Manzoni; Giovanni A Rossi; Silvia Vandini; Alessandro Rimini; Costantino Romagnoli; Pierluigi Colonna; Andrea Biondi; Paolo Biban; Giampietro Chiamenti; Roberto Bernardini; Marina Picca; Marco Cappa; Giuseppe Magazzù; Carlo Catassi; Antonio Francesco Urbino; Luigi Memo; Gianpaolo Donzelli; Carlo Minetti; Francesco Paravati; Giuseppe Di Mauro; Filippo Festini; Susanna Esposito; Giovanni Corsello Journal: Ital J Pediatr Date: 2014-10-24 Impact factor: 2.638
Authors: Jonathan M Mansbach; Sunday Clark; Pedro A Piedra; Charles G Macias; Alan R Schroeder; Brian M Pate; Ashley F Sullivan; Janice A Espinola; Carlos A Camargo Journal: J Hosp Med Date: 2015-01-28 Impact factor: 2.960
Authors: Lise Beier Havdal; Britt Nakstad; Hans Olav Fjærli; Christian Ness; Christopher Inchley Journal: Eur J Pediatr Date: 2021-04-08 Impact factor: 3.183
Authors: Christopher D Mangum; Rachel L Andam-Mejia; Leslie R Hale; Ana Mananquil; Kyle R Fulcher; Jason L Hall; Laura Anne C McDonald; Karl N Sjogren; Felicita D Villalon; Ami Mehta; Kyrie Shomaker; Edward A Johnson; Sandip A Godambe Journal: Pediatr Qual Saf Date: 2021-09-24