Perlstein P H, Kotagal U R, Schoettker P J, Atherton H D, Farrell M K, Gerhardt W E, Alfaro M P
Division of Health Policy and Clinical Effectiveness, Children's Hospital Medical Center, Cincinnati, OH, USA.
Arch Pediatr Adolesc Med. 2000 Oct;154(10):1001-7. doi: 10.1001/archpedi.154.10.1001.
To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis.
Before and after study.
Children's Hospital Medical Center, Cincinnati, Ohio.
Infants 1 year or younger admitted to the hospital with a first-time episode of typical bronchiolitis.
The guideline was implemented January 15, 1997. Data on all patients discharged from the hospital with bronchiolitis, from January 15 through March 27, in 1997, 1998, and 1999, were stratified by year and compared with data on similar patients discharged from the hospital in the same periods in the years 1993 through 1996.
Patient volumes, length of stay for admissions, and use of specific laboratory and therapeutic resources ancillary to bed occupancy.
After implementation of the guideline, admissions decreased 30% and mean length of stay decreased 17% (P<.001). Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients (P<.001); 14% fewer chest x-ray films were ordered (P<.001). There were significant reductions in the use of all respiratory therapies, with a 17% decrease in the use of at least 1 beta(2)-agonist inhalation therapy (P<.001). In addition, 28% fewer repeated inhalations were administered (P<.001); mean costs for all resources ancillary to bed occupancy fell 41% (P<.001); and mean costs for respiratory care services fell 72% (P<.001).
An evidence-based clinical practice guideline for the care of patients encountered in major pediatric care facility has been successfully sustained beyond the initial year of its introduction to practitioners in southwest Ohio.
描述实施基于证据的毛细支气管炎婴儿护理临床实践指南后3年内发生的变化。
前后对照研究。
俄亥俄州辛辛那提市儿童医院医疗中心。
1岁及以下首次因典型毛细支气管炎入院的婴儿。
该指南于1997年1月15日实施。对1997年、1998年和1999年1月15日至3月27日期间所有因毛细支气管炎出院的患者数据按年份进行分层，并与1993年至1996年同期从该医院出院的类似患者数据进行比较。
患者数量、住院时间以及与床位占用相关的特定实验室和治疗资源的使用情况。
实施该指南后，入院人数减少了30%，平均住院时间减少了17%（P<0.001）。进行呼吸道合胞病毒鼻咽冲洗的患者减少了52%（P<0.001）；胸部X光检查的医嘱减少了14%（P<0.001）。所有呼吸治疗的使用均显著减少，至少进行1次β2受体激动剂吸入治疗的使用减少了17%（P<0.001）。此外，重复吸入治疗减少了28%（P<0.001）；与床位占用相关的所有资源的平均成本下降了41%（P<0.001）；呼吸护理服务的平均成本下降了72%（P<0.001）。
俄亥俄州西南部一家主要儿科护理机构针对患者护理的基于证据的临床实践指南，在向从业者推出后的最初一年之后成功得以持续实施。
