Evaluation of the effectiveness of a clinical pathway for bronchiolitis

Abstract

Objective: This study examines the use of a clinical pathway in the management of infants hospitalised with bronchiolitis.

Study Design: A clinical pathway for the care of infants with bronchiolitis was developed from pathways used in tertiary paediatric institutions in Australia. 229 infants admitted to hospital with acute viral bronchiolitis and prospectively managed using a pathway protocol were compared with a retrospective analysis of 207 infants managed without a pathway in three regional and one tertiary hospital.

Results: There were no differences between groups in demographic factors or clinical severity. The pathway had no effect on length of stay or time in oxygen. Readmission to hospital was significantly lower in the pathway group (P = 0.001). Administration of supplemental fluids (P = 0.001) and use of steroids was lower (P = 0.005) in the pathway group. Identification of parental smoking status was higher in the pathway group (P = 0.029). Data from the pathway demonstrated that boys were three times more likely to return to oxygen after weaning to air (OR = 3.30; 95%CI 1.39 - 7.81) after adjusting for admission oxygen saturation. Documentation of variances from the pathway was misunderstood by staff.

Conclusions: A clinical pathway specifying local practice guidelines and discharge criteria can reduce the risk of readmission to hospital, the use of inappropriate therapies, and help with assessment of readiness for discharge.