PEDIATRICS Vol. 104 No. 6 December 1999, pp. 1334-1341
Evaluation of an Evidence-based Guideline for Bronchiolitis
Received Mar 19, 1999; accepted Jun 2, 1999.
,
From the * Divisions of Health Policy and Clinical Effectiveness
and Gastroenterology and Nutrition, Children's Hospital Medical
Center, Cincinnati, Ohio; the § Institute for Health Policy and Health
Services Research, University of Cincinnati, Cincinnati, Ohio;
¶ Children's Clinic, Springfield, Missouri; and Pediatric
Associates of Northern Kentucky, Crestview Hills, Kentucky.
Objective. To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio.
Methodology. A multidisciplinary team generated the
guideline for infants 
1 year old who were admitted to the hospital
with a first-time episode of typical bronchiolitis. The guideline was
implemented January 15, 1997, and data on all patients admitted with
bronchiolitis from that date through March 27, 1997, were compared with
data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and
financial databases. They included LOS and use and costs of resources
ancillary to bed occupancy.
Results. After implementation of the guideline, admissions
decreased 29% and mean LOS decreased 17%.
Nasopharyngeal washings for respiratory syncytial virus were obtained
in 52% fewer patients. Twenty percent fewer chest radiographs
were ordered. There were significant reductions in the use of all
respiratory therapies, with a 30% decrease in the use of at least 1 
-agonist inhalation therapy. In addition, 51% fewer repeated
inhalations were administered. Mean costs for all resources ancillary
to bed occupancy decreased 37%. Mean costs for respiratory care
services decreased 77%.
Conclusions. An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research. .
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