McCoy Elisha, Chumpia Maryanne
Le Bonheur Children's Hospital, Memphis, Tennessee; and
Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Hosp Pediatr. 2018 Oct;8(10):651-657. doi: 10.1542/hpeds.2017-0214.
Bronchiolitis is a leading cause of pediatric hospitalizations in the United States. Although the American Academy of Pediatrics recommends against routine use of bronchodilators in bronchiolitis management, racemic epinephrine was persistently used for this purpose at Le Bonheur Children's Hospital. Our aim was to decrease racemic epinephrine use for bronchiolitis by 50% within 8 months.
Our multidisciplinary team used the Institute for Healthcare Improvement's Model for Improvement to develop an aim statement, choose metrics, and perform plan-do-study-act cycles to reduce racemic epinephrine use. We used focused education through in-person and online methods and provided direct feedback to residents, respiratory therapists, and nurses primarily caring for these children. The percentage of all patients admitted for bronchiolitis receiving at least 1 dose of racemic epinephrine was collected from the medical record and recorded on statistical process control charts for distribution to their work areas. Albuterol use and length of stay were collected as balancing measures. We used statistical process control charts to establish special cause variation and identify statistically significant differences in our measures.
During our intervention period, the percentage of bronchiolitis patients receiving at least 1 dose of racemic epinephrine to treat bronchiolitis decreased from an average of 26% to 5%, and similarly, albuterol use decreased from an average of 48% to 34%. There was no clinically significant difference in length of stay.
Using a multidisciplinary approach and focused education techniques may be an effective way to reduce racemic epinephrine use for children with bronchiolitis.
在美国，细支气管炎是导致儿童住院的主要原因。尽管美国儿科学会建议在细支气管炎治疗中不常规使用支气管扩张剂，但勒博内尔儿童医院仍持续将消旋肾上腺素用于此目的。我们的目标是在8个月内将用于细支气管炎的消旋肾上腺素使用量减少50%。
我们的多学科团队采用医疗保健改进研究所的改进模型来制定目标声明、选择指标，并执行计划-执行-研究-行动循环以减少消旋肾上腺素的使用。我们通过面对面和在线方式进行集中教育，并主要向直接护理这些患儿的住院医师、呼吸治疗师和护士提供直接反馈。从病历中收集所有因细支气管炎入院且接受至少一剂消旋肾上腺素治疗的患者百分比，并记录在统计过程控制图上，以便分发给他们的工作区域。收集沙丁胺醇的使用情况和住院时间作为平衡指标。我们使用统计过程控制图来确定特殊原因变异，并识别我们所测量指标的统计学显著差异。
在我们的干预期间，接受至少一剂消旋肾上腺素治疗细支气管炎的患者百分比从平均26%降至5%，同样，沙丁胺醇的使用从平均48%降至34%。住院时间没有临床显著差异。
采用多学科方法和集中教育技术可能是减少细支气管炎患儿消旋肾上腺素使用的有效方法。
