Introduction: Bronchiolitis is one of the most common infectious diseases of childhood and the most frequent cause of infant hospitalizations. Clinical practice guidelines recommend that routine chest radiography (CXR) is not necessary for the diagnosis of bronchiolitis, as studies have shown that they do not affect outcomes, but rather lead to unnecessary treatments and hospitalizations. Due to variable adherence to these guidelines we conducted a quality improvement intervention that included didactic sessions as well as guideline cards positioned throughout the ED. We recently published the intervention`s success in reducing CXRs the year of the intervention.
Objective: To determine whether the effects of the intervention persisted up to 3 years. The primary outcome was the frequency of CXRs ordered in the ED. Secondary outcomes included the effect on hospitalization rate and medication use.
Methods: Prospective data obtained during the study period was compared with retrospective data from the year of the intervention.
Results: There was no significant increase in the frequency of CXRs ordered in the hospital; 50.2% of study group patients underwent CXR vs. 45.6% in the retrospective cohort (p=0.2). During the study period there was no difference in the length of stay, however a reduction in hospitalization rate (57.7% vs. 69.8%, p=0.00043) was noted.
Conclusion: The intervention led to a long-lasting change in management practices leading to less radiation exposure, less hospitalizations and a shorter average length of stay.
