Improving Length of Stay in Patients Hospitalized with Bronchiolitis Using an Updated Clinical Pathway

ABSTRACT

Purpose/Objectives: Bronchiolitis is the most common cause of lower respiratory infections in young children. Studies have demonstrated that improved adherence to an evidenced-based clinical pathway is associated with shorter lengths of stay and lower costs. Despite having a bronchiolitis clinical pathway, the average length of stay of bronchiolitis patients at our tertiary care center was higher than published data showing a national average around 2.5 days. The specific aim of this project was to decrease the average length of stay of patients aged 0-24 months who are admitted with bronchiolitis from a baseline of 2.9 days during the 2019-2020 bronchiolitis season to a goal of 2.5 days by the end of the season in March 2021. Design/Methods: A multidisciplinary task group including hospitalists, respiratory therapy, and nursing was organized to revise and update our current bronchiolitis pathway, protocol, and electronic medical record (EMR) order set. Using a data report tool that was built by IT and linked to our EMR, real time institutional data was obtained and reviewed monthly. Staff feedback was solicited leading to the identification and implementation of the following interventions which were implemented in November 2020 • Decreasing the oxygen saturation goal to 88% for initiating oxygen and for admission and discharge criteria • Improving patient education by updating family education handouts and developing standardized discharge instructions • Adding nursing communication and activatable discharge orders that list the discharge criteria Our primary outcome measure was the monthly average length of stay of admitted bronchiolitis patients. Our process measure was the utilization rate of our bronchiolitis order set. Our balancing measures were the number of intensive care unit (ICU) transfers and the 7-day readmission rate to the hospital and emergency department (ED). Results: We observed the average length of stay during the period of November 2019-March 2020 decreased from 2.9 days to 1.7 days during the November 2020- March 2021 time period (Figure 1). The order set utilization rate during these periods remained high, but decreased somewhat from 85% to 70%. Balancing measures during these periods showed a decrease in ICU transfer rate from 4.76% to 0% and a decrease in the ED/Inpatient readmission rate from 2.45% to 0% (Figure 2). Conclusion/Discussion: The revision of the bronchiolitis clinical pathway coupled with caregiver and family education correlated with a significant reduction in the length of stay of admitted bronchiolitis patients at our tertiary care hospital. However, the coronavirus pandemic drastically reduced the volume of bronchiolitis patients in the 2020-2021 season, with our hospital experiencing a 93% decrease in admissions for this diagnosis. While this project's results are highly encouraging, the coronavirus pandemic and low admission numbers make drawing clear conclusions difficult, and ongoing monitoring will be essential to see if this trend is sustainable.