Brian M. Pate

Decreasing unnecessary utilization in acute bronchiolitis care: Results from the value in inpatient pediatrics network

BACKGROUND Acute viral bronchiolitis is the most common diagnosis resulting in hospital admission in pediatrics. Utilization of non-evidence-based therapies and testing remains common despite a large volume of evidence to guide quality improvement efforts. OBJECTIVE Our objective was to reduce utilization of unnecessary therapies in the inpatient care of bronchiolitis across a diverse network of clinical sites. METHODS We formed a voluntary quality improvement collaborative of pediatric hospitalists for the purpose of benchmarking the use of bronchodilators, steroids, chest radiography, chest physiotherapy, and viral testing in bronchiolitis using hospital administrative data. We shared resources within the network, including protocols, scores, order sets, and key bibliographies, and established group norms for decreasing utilization. RESULTS Aggregate data on 11,568 hospitalizations for bronchiolitis from 17 centers was analyzed for this report. The network was organized in 2008. By 2010, we saw a 46% reduction in overall volume of bronchodilators used, a 3.4 dose per patient absolute decrease in utilization (95% confidence interval [CI] 1.4-5.8). Overall exposure to any dose of bronchodilator decreased by 12 percentage points as well (95% CI 5%-25%). There was also a statistically significant decline in chest physiotherapy usage, but not for steroids, chest radiography, or viral testing. CONCLUSIONS Benchmarking within a voluntary pediatric hospitalist collaborative facilitated decreased utilization of bronchodilators and chest physiotherapy in bronchiolitis.

Diagnosis and acute management of patients with concussion at children's hospitals

Objectives To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients. Design Cross-sectional study. Setting Childrens hospitals participating in the Pediatric Health Information System in the USA during a 10-year period. Patients All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion. Main outcome measures The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion. Results The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US

Risk Factors for Requiring Intensive Care Among Children Admitted to Ward With Bronchiolitis

695, IQR US

Clinical Impact of an Antimicrobial Stewardship Program on Pediatric Hospitalist Practice, a 5-Year Retrospective Analysis

472–

Hospital course and discharge criteria for children hospitalized with bronchiolitis

1009, vs US

Use of Cough and Cold Medications in Severe Bronchiolitis before and after a Health Advisory Warning against Their Use

191, IQR US

Variability of Intensive Care Management for Children With Bronchiolitis

114–

The Pediatric Hospital Medicine Core Competencies Supplement: a Framework for Curriculum Development by the Society of Hospital Medicine with acknowledgement to pediatric hospitalists from the American Academy of Pediatrics and the Academic Pediatric Association.

287). An ED visit with CT, however, cost less than a hospitalisation without CT (US

Clinical Impact of an Antimicrobial Stewardship Program on Pediatric Hospitalist Practice, a 5-year Retrospective Analysis

1907, IQR US

Change to a Standardized Airway Clearance Protocol for Children With Bronchiolitis Leads to

1292–