Methods: Five hospitalist groups incorporated the WARM (wheeze, air exchange, respiratory rate, muscle use) respiratory score into their bronchiolitis protocols, but the individual protocols varied. Data were retrospectively collected on all children less than 24 months of age with a primary diagnosis of acute viral bronchiolitis admitted to observation or inpatient status from 2007 to 2010. Patients admitted to intensive care or who had chronic lung diseases, asthma, chromosomal abnormalities, congenital heart disease or neurological diseases were excluded. Bronchodilator utilization was measured by the overall percentage of patients who received any dose of bronchodilator and the total number of bronchodilator doses used during the year. Data were analyzed on the hospital level using repeated measures mixed models with year treated as a continuous variable from 1 to 4; correlation within hospital over time was modeled with an autoregressive correlation structure. All tests were two-tailed and performed at a significance level of 0.05 using SAS 9.2 software (SAS Institute, Cary, NC).
Results: Over the intervention period from 2007-2010, there was a significant decrease in the percentage of patients who received bronchodilators over all 5 institutions, an average of 8% per year (P=0.004). There was a significant decrease in the number of bronchodilator doses given during the intervention period, reported as the mean number of bronchodilator doses per patient, which decreased by an average of 1 per year (P=0.036). The average length of stay and readmission rate did not change significantly at any of the 5 institutions over the intervention period.
Conclusion: Use of a standardized respiratory scoring system and a threshold score prior to intervention decreases unnecessary bronchodilator usage in bronchiolitis across diverse clinical settings without increasing length of stay or readmission rate.