MBChB, Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
Pediatrics. 2014 Jan;133(1):e227-34. doi: 10.1542/peds.2013-1991. Epub 2013 Dec 9.
Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED).
We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).
There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.
A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.
细支气管炎是婴儿发病的主要原因，会导致医疗保健费用增加数百万美元。护理指南通过减少不必要的资源利用来降低成本。通过实施指南，我们试图减少不必要的资源利用，并提高小儿急诊科患有细支气管炎的婴儿的护理价值。
我们进行了一项中断时间序列研究，共纳入了 2007 年 11 月至 2013 年 4 月期间 2929 名 1 至 12 个月龄患有细支气管炎的婴儿的急诊科就诊情况。观察指标包括胸部 X 线（CXR）、呼吸道合胞病毒（RSV）检测、沙丁胺醇或抗生素使用的比例，以及护理总成本。平衡措施包括入院率、出院后 72 小时内返回急诊科导致再次入院的比例，以及急诊科住院时间（LOS）。
在结果方面没有发现明显的先前趋势。在指南实施后，CXR 的绝对减少了 23%（95%置信区间 [CI]：11%至 34%），RSV 检测的绝对减少了 11%（95% CI：6%至 17%），沙丁胺醇使用的绝对减少了 7%（95% CI：0.2%至 13%），急诊科 LOS 的绝对减少了 41 分钟（95% CI：16 至 65 分钟）。每位患者的平均成本降低了 197 美元（95% CI：136 美元至 259 美元）。在实施指南后的 2 个细支气管炎季节，总成本节省了 196409 美元（95% CI：135592 美元至 258223 美元）。抗生素使用、入院率或出院后 72 小时内再次入院的比例没有显著差异。
在小儿急诊科，细支气管炎指南与 CXR、RSV 检测、沙丁胺醇使用、急诊科 LOS 和总成本的降低有关。
