ABSTRACT
CONTEXT: Bronchiolitis is the most common lower respiratory tract infection in infancy. A recent Centers for Disease Control and Prevention report confirmed that hospitalization rates for bronchiolitis have increased 2.4-fold from 1980 to 1996. Controversies exist about optimal treatment plans. Milliman and Robertson recommend ambulatory care management; in case of hospitalization, the recommended length of stay is 1 day. OBJECTIVES: To relate actual practice variation for infants admitted with uncomplicated bronchiolitis to Milliman and Robertson's recommendations. DESIGN: Prospective observational study. SETTING: General care wards of 8 pediatric hospitals of the Child Health Accountability Initiative during the winter of 1998-1999. PATIENTS: First-time admissions for uncomplicated bronchiolitis in patients not previously diagnosed as having asthma and who were younger than 1 year. MAIN OUTCOME MEASURES: Respiratory rate, monitored interventions, attainment of discharge criteria goals, and length of stay. RESULTS: Eight hundred forty-six patients were included in the final analysis: 85.7% were younger than 6 months, 48.5% were nonwhite, and 64.1% were Medicaid recipients or self-pay. On admission to the hospital, 18.3% of the infants had respiratory rates higher than higher than 80 breaths per minute, 53.8% received supplemental oxygen therapy, and 52.6% received intravenous fluids. These proportions decreased to 1.9%, 33.8%, and 20.3%, respectively, 1 day after admission, and to 0.7%, 20.1%, and 8.6%, respectively, 2 days after admission. The average length of stay was 2.8 days (SD, 2.3 days). CONCLUSIONS: Milliman and Robertson's recommendations do not correspond to practice patterns observed at the hospitals participating in this study; no hospital met the Milliman and Robertson recommended 1-day goal length of stay. Administration of monitored intervention persisted past the second day of hospitalization.
Subject(s)
Ambulatory Care , Bronchiolitis/therapy , Hospitalization , Practice Guidelines as Topic , Fluid Therapy , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Length of Stay , Outcome and Process Assessment, Health Care , Oxygen Inhalation Therapy , Practice Patterns, Physicians' , Prospective StudiesABSTRACT
This investigation answered the question, What meaning do parents give to the decision to authorize or to withdraw or forgo authorization of life-sustaining treatment for a child? Using an exploratory design, the author interviewed 20 families who had faced this decision in the prior 6 to 12 months. From content analysis, parents' essential meaning was experienced through their sense of self, their being, and an ethic of responsibility. Parents' decisions reflected values regarding the eight key themes of life, pain and suffering, quality of life, not self, respect for person or best interest, family, faith and nature, and technology.
Subject(s)
Decision Making , Ethics , Life Support Care , Parents , Social Values , Adolescent , Adult , Attitude to Death , Attitude to Health , Child , Child, Preschool , Family , Female , Humans , Infant , Male , Medical Laboratory Science , Pain , Parents/psychology , Quality of Life , ReligionABSTRACT
When a child becomes critically ill, stable patterns of parental routines are changed. Although the resulting stress on parents has long been recognized by clinicians, only recently has research addressed parental needs during a child's illness.
