Putting New Bronchiolitis Guidelines to the Test

New bronchiolitis guidelines saved money without changing patient outcomes

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) New guidelines for treating certain diseases are sometimes issued to save money and improve patients' care. But doctors may need an extra push to follow them.

A recent study found that reducing the use of tests and certain treatments for patients with bronchiolitis saved money without hurting patient care.

The change in usage was the result of a hospital-wide guideline implemented to match the guidelines of the American Academy of Pediatrics.

Knowing that certain tests may be unnecessary can help patients talk to doctors about the care they or their children receive.

"Ask the doctor about your child's treatment options."

The study, led by Ayobami T. Akenroye, MPH, of the Division of Emergency Medicine at Boston Children's Hospital, looked at the effects of implementing new guidelines for the diagnosis and treatment of bronchiolitis.

The American Academy of Pediatrics introduced new guidelines for bronchiolitis diagnosis and treatment in 2006, but they were not followed consistently by all doctors.

Therefore, Boston Children's Hospital developed guidelines based on the AAP ones to implement throughout the hospital over the period from October 2010 to June 2011.

The hospitals guidelines recommended no routine testing for viruses, no routine chest x-rays, and no routine administration of antibiotics.

To see the effects of this implementation, researchers examined the care and outcomes of 2,929 patients with bronchiolitis between November 2007 and April 2013.

The results showed a substantial drop in costly interventions with no significant changes that appeared related to patients' outcomes.

After the guidelines were introduced, the use of chest x-rays dropped 23 percentage points, and the use of testing for respiratory syncytial virus (RSV) dropped 11 percentage points.

In addition, the use of albuterol — a "bronchodilator" medication that expands the airways to improve airflow — dropped by 7 percentage points.

These changes resulted in costing $197 less per patient, which added up to nearly $200,000 over two bronchiolitis seasons at the hospital.

Meanwhile, the time patients spent in the emergency department also decreased by an average of 41 minutes, but there was no increase in hospital admissions for patients.

There were also no major changes in return visits within three days from patients that led to admission to the hospital.

The researchers concluded that the use of bronchiolitis guidelines at this hospital resulted in fewer tests and treatments without affecting the number of patients who needed admission to the hospital.

The study was published December 9 in the journal Pediatrics. The research was funded by Boston Children's Hospital, and the authors declared no conflicts of interest.

Review Date: 
December 9, 2013
Last Updated:
December 9, 2013