Knowledge Translation in Western Australia Tertiary Paediatric Emergency Department: An Audit Cycle of Effectiveness of Standard Education on Updated Bronchiolitis Guideline

Background: Bronchiolitis is the most common cause of presentation and hospitalization for infants in Australia and New Zealand. Multiple clinical practice guidelines have been published to minimize unncesssary interventions in infants with bronchiolitis; however, the challenge is translating the knowledge and evidence into clinical practice.

Objective: The objective of this audit cycle was to determine if standard education process of the updated bronchiolitis guideline in a tertiary paediatric emergency department (ED) will reduce unnecessary interventions in infants with bronchiolitis.

Methods: A retrospective chart review was conducted in a tertiary paediatric ED of bronchiolitis presentations in 2015 (pre-education cohort of 465 presentations) and in 2017 (post education cohort of 343 presentations) after implementation of the updated guideline prior to the 2017 bronchiolitis season. The primary outcome was to evaluate the rate of interventions shown to be ineffectual in the updated guideline with secondary outcomes evaluating the rate of hospital, ICU admissions and the rate of multiple interventions versus single intervention.

Results: There was no difference found between 2015 and 2017 for chest x-ray, salbutamol, adrenaline, antibioitics and nasopharyngeal aspirates. There was increased use of glucocorticoids with increased odds of 60% (p=0.002) which was statistically significant. There was no difference with the number of interventions between 2015 and 2017. Hospital admissions were reduced from 2015 to 2017 (65.2% versus 56.0% respectively), with reduced odds of admission of 18% (p=0.008) that was statistically significant. There was no difference in ICU admissions.

Conclusion: The updated guideline through standard education process in ED did not show any statistically significant reduction of unncessary interventions. Community initiated glucocorticoid administration, however, was increased. A larger multi-centered study will be beneficial to determine if the awareness of the guideline to the broader community would reduce unnessary interventions as well as the challenge of translating current evidence into clinical practice.