Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs : a quality-of-care initiative in a Spanish autonomous community
OBJECTIVES: To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis.
MATERIAL AND METHODS: Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started.
RESULTS: A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001).
CONCLUSION: The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias - 35(2023), 1 vom: 02. Feb., Seite 31-38 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
Iniciativa de mejora para reducir el uso de fármacos no recomendados en el manejo de lactantes con bronquiolitis aguda en los servicios de urgencias de una comunidad autónoma |
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| Beteiligte Personen: |
Andina Martínez, David [VerfasserIn] |
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| Anmerkungen: |
Date Completed 10.02.2023 Date Revised 14.05.2023 published: Print Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352667583 |
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| 100 | 1 | |a Andina Martínez, David |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs |b a quality-of-care initiative in a Spanish autonomous community |
| 246 | 3 | 3 | |a Iniciativa de mejora para reducir el uso de fármacos no recomendados en el manejo de lactantes con bronquiolitis aguda en los servicios de urgencias de una comunidad autónoma |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 10.02.2023 | ||
| 500 | |a Date Revised 14.05.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis | ||
| 520 | |a MATERIAL AND METHODS: Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started | ||
| 520 | |a RESULTS: A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001) | ||
| 520 | |a CONCLUSION: The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bronchitis, acute. | |
| 650 | 4 | |a Bronchodilator agents. | |
| 650 | 4 | |a Broncodilatadores. | |
| 650 | 4 | |a Bronquiolitis aguda. | |
| 650 | 4 | |a Emergency health services. | |
| 650 | 4 | |a Estrategia de mejora de la calidad. | |
| 650 | 4 | |a Guías de práctica clínica. | |
| 650 | 4 | |a Practice guideline. | |
| 650 | 4 | |a Servicios de urgencias. | |
| 650 | 4 | |a Total quality management. | |
| 650 | 7 | |a Albuterol |2 NLM | |
| 650 | 7 | |a QF8SVZ843E |2 NLM | |
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| 700 | 1 | |a Arnaiz Diumenjo, Yago |e verfasserin |4 aut | |
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| 700 | 1 | |a Muñoz López, Cristina |e verfasserin |4 aut | |
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| 700 | 1 | |a Bautista Lozano, Diego |e verfasserin |4 aut | |
| 700 | 1 | |a Lagares Velasco, Almudena |e verfasserin |4 aut | |
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| 700 | 1 | |a Rivas Crespo, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Prieto Martínez, Shaila |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz González, Sara |e verfasserin |4 aut | |
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