BACKGROUND: Bronchiolitis is a viral lower respiratory tract infection that causes significant morbidity and mortality in the pediatric population. Viral diagnostic testing (VDT) has been used to identify specific viral pathogens. However, current guidelines suggest that routine use of this testing is not advisable. For children admitted to a children's hospital from the pediatric emergency department (PED), the rate of VDT was 63%, which was higher than the national rate. A quality improvement project was conducted to reduce the use of routine VDT. METHODS: Key drivers of VDT were identified, and interventions, which included staff education about the cost and use of VDT and dissemination of a simplified cohorting policy aimed to eliminate VDT without medical necessity, were implemented through the PED and inpatient unit settings. RESULTS: Between January 2017 and April 2017, VDT use in all non-ICU patients admitted from the PED with bronchiolitis decreased from 63% to 12%. In the same time period, patients with VDT sent from the PED fell from 53% to 14%. A reduction in VDT for patients admitted with asthma exacerbation was also observed-from 24% to 0%-demonstrating early spread of these effects. Cost savings of approximately $8,584 per year in direct supply costs alone was documented. CONCLUSION: Using simple, low-cost interventions, including education and guideline refinement, the rate of VDT use for bronchiolitis was significantly reduced. Further directions for this project include the reduction of routine testing for patients with bronchiolitis who are admitted to the ICU or discharged for outpatient care.
BACKGROUND:Bronchiolitis is a viral lower respiratory tract infection that causes significant morbidity and mortality in the pediatric population. Viral diagnostic testing (VDT) has been used to identify specific viral pathogens. However, current guidelines suggest that routine use of this testing is not advisable. For children admitted to a children's hospital from the pediatric emergency department (PED), the rate of VDT was 63%, which was higher than the national rate. A quality improvement project was conducted to reduce the use of routine VDT. METHODS: Key drivers of VDT were identified, and interventions, which included staff education about the cost and use of VDT and dissemination of a simplified cohorting policy aimed to eliminate VDT without medical necessity, were implemented through the PED and inpatient unit settings. RESULTS: Between January 2017 and April 2017, VDT use in all non-ICU patients admitted from the PED with bronchiolitis decreased from 63% to 12%. In the same time period, patients with VDT sent from the PED fell from 53% to 14%. A reduction in VDT for patients admitted with asthma exacerbation was also observed-from 24% to 0%-demonstrating early spread of these effects. Cost savings of approximately $8,584 per year in direct supply costs alone was documented. CONCLUSION: Using simple, low-cost interventions, including education and guideline refinement, the rate of VDT use for bronchiolitis was significantly reduced. Further directions for this project include the reduction of routine testing for patients with bronchiolitis who are admitted to the ICU or discharged for outpatient care.