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Decrease in the use of bronchodilators in the management of bronchiolitis after applying improvement initiatives.
Andina Martínez, David; Escalada Pellitero, Silvia; Viaño Nogueira, Pedro; Alonso Cadenas, Jose Antonio; Martín Díaz, María José; de la Torre-Espi, Mercedes; Jiménez García, Raquel.
Afiliación
  • Andina Martínez D; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. Electronic address: david.andina@salud.madrid.org.
  • Escalada Pellitero S; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • Viaño Nogueira P; Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • Alonso Cadenas JA; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • Martín Díaz MJ; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • de la Torre-Espi M; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
  • Jiménez García R; Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
An Pediatr (Engl Ed) ; 96(6): 476-484, 2022 Jun.
Article en En | MEDLINE | ID: mdl-35644761
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Broncodilatadores / Bronquiolitis Tipo de estudio: Guideline / Observational_studies Límite: Child / Humans Idioma: En Revista: An Pediatr (Engl Ed) Año: 2022 Tipo del documento: Article Pais de publicación: España
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Broncodilatadores / Bronquiolitis Tipo de estudio: Guideline / Observational_studies Límite: Child / Humans Idioma: En Revista: An Pediatr (Engl Ed) Año: 2022 Tipo del documento: Article Pais de publicación: España