Decrease in the use of bronchodilators in the management of bronchiolitis after applying improvement initiatives
Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved..
INTRODUCTION: In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines.
MATERIAL AND METHODS: A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out.
RESULTS: 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6-55.8%) in 2012 to 7.8% (95% CI: 5.7%-10.5%) in 2018 (P < .001) and epinephrine prescription rates fell from 12.9% (95% CI: 10.1%-16.3%) to 0.2% (95% CI: 0-1.1%) (P < .001). At the same time, there was a decrease in the median time of attendance in the Emergency Department and in the admission rate without changing the readmission rate in 72 h.
CONCLUSIONS: The systematic and continuous deployment over time of actions aimed at reducing the use of salbutamol and epinephrine in the treatment of bronchiolitis, prior to the epidemic period, seems an effective strategy to reduce the use of bronchodilators in the Emergency Department.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:96 |
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| Enthalten in: |
Anales de pediatria - 96(2022), 6 vom: 26. Juni, Seite 476-484 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Andina Martínez, David [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 21.06.2022 Date Revised 21.06.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.anpede.2021.05.014 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM341668052 |
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| 100 | 1 | |a Andina Martínez, David |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Decrease in the use of bronchodilators in the management of bronchiolitis after applying improvement initiatives |
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| 500 | |a Date Revised 21.06.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION: In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines | ||
| 520 | |a MATERIAL AND METHODS: A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out | ||
| 520 | |a RESULTS: 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6-55.8%) in 2012 to 7.8% (95% CI: 5.7%-10.5%) in 2018 (P < .001) and epinephrine prescription rates fell from 12.9% (95% CI: 10.1%-16.3%) to 0.2% (95% CI: 0-1.1%) (P < .001). At the same time, there was a decrease in the median time of attendance in the Emergency Department and in the admission rate without changing the readmission rate in 72 h | ||
| 520 | |a CONCLUSIONS: The systematic and continuous deployment over time of actions aimed at reducing the use of salbutamol and epinephrine in the treatment of bronchiolitis, prior to the epidemic period, seems an effective strategy to reduce the use of bronchodilators in the Emergency Department | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bronchodilator agents | |
| 650 | 4 | |a Broncodilatadores | |
| 650 | 4 | |a Bronquiolitis aguda | |
| 650 | 4 | |a Emergency medical services | |
| 650 | 4 | |a Estrategia de mejora de la calidad | |
| 650 | 4 | |a Guías de práctica clínica | |
| 650 | 4 | |a Hospital pediatrics | |
| 650 | 4 | |a Pediatría hospitalaria | |
| 650 | 4 | |a Practice guidelines | |
| 650 | 4 | |a Quality improvement | |
| 650 | 4 | |a Servicios de Urgencias | |
| 650 | 4 | |a Viral bronchiolitis | |
| 650 | 7 | |a Bronchodilator Agents |2 NLM | |
| 650 | 7 | |a Albuterol |2 NLM | |
| 650 | 7 | |a QF8SVZ843E |2 NLM | |
| 650 | 7 | |a Epinephrine |2 NLM | |
| 650 | 7 | |a YKH834O4BH |2 NLM | |
| 700 | 1 | |a Escalada Pellitero, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Viaño Nogueira, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Alonso Cadenas, Jose Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Martín Díaz, María José |e verfasserin |4 aut | |
| 700 | 1 | |a de la Torre-Espi, Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Jiménez García, Raquel |e verfasserin |4 aut | |
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