Multimodal implementation of clinical practice guidelines on bronchiolitis: Ending the overuse of diagnostic resources

• Published in: Anales de Pediatría 2018-12, Vol.89 (6), p.352-360
• Main Authors: Maraña Pérez, Ana Isabel, Rius Peris, Juan Manuel, Rivas Juesas, Cristina, Torrecilla Cañas, Javier, Hernández Muelas, Sara, de la Osa Langreo, Alberto
• Format: Article
• Language: English
• Subjects: Bronchiolitis; Bronquiolitis; Clinical practice guidelines; Diagnostic resources; Guía de Práctica Clínica; Overuse; Recursos diagnósticos; Uso excesivo
• ISSN: 2341-2879; 2341-2879
• DOI: 10.1016/j.anpede.2018.02.007

Clinical practice guidelines have been shown to be valuable tools for guiding medical decisions. However, their mere publication has not reduced the variability of practice in terms of the way acute bronchiolitis is managed. A before-and-after study design was used to analyse the effectiveness of a method of disseminating diagnostic recommendations among physicians regarding the management of infants, hospitalised due to bronchiolitis. Patients with comorbidities, ex-premature patients, and patients transferred to other hospitals were excluded. The diagnostic resources studied were: chest X-ray, full blood count, C-reactive protein, blood culture, venous blood gas, and determination of the respiratory syncytial virus. Eleven epidemic periods were analysed. A total of 259 patients were studied including 98 in the pre-intervention group (2006–2010), and 131 in the post-intervention group (2011–2017). The intervention took place in October of 2010 and 2011. A comparison of the two periods showed that the use of chest X-rays dropped from 73.5% to 16% (P