614 Reducing hospital admission and ensuring safe discharge of <3month old infants with bronchiolitis in a hospital@home service: a DGH experience

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A117-A118
• Main Authors: Kiani, Sadaf, Manuel, Anthea, Palanivelu, Priya, Goldring, Stephen, Tyrrell, Madeline
• Format: Article
• Language: English
• Subjects: Adverse events; Apnea; Bronchopneumonia; Children; Community Relations; Diagnosis; Emergency medical care; Guidelines; Hospitalization; Hospitals; Hypoventilation; Infants; Patients; Pediatrics; Primary care; Referral; Risk factors; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.195

ObjectiveBronchiolitis is a leading causes of hospital admission in children under two. In May 2021 our children’s hospital@home service, PATCH (Providing Assessment and Treatment for Children at Home), began after collaborating with neighbouring trusts. We have seen significant reduction in hospital admissions for bronchiolitis (26% to 14%) since adopting this. However, we noticed regular PATCH referrals of infants under 3 months with bronchiolitis, contrary to our guideline. NICE guidance recognises age under 3 months as a risk factor for severe bronchiolitis1 and advocates taking this into account in admission decisions. NHS Healthier Together Bronchiolitis pathway suggests that infants under 6 weeks with bronchiolitis could be referred to an acute paediatric community nursing team.2 Our objective was to look at the clinical features and outcomes for these young infants and adapt our guideline as appropriate.MethodsThe list of patients referred to PATCH for bronchiolitis October-December 2021 was reviewed retrospectively to identify infants under 3 months. Data were recorded from patients’ electronic notes. Clinical features on referral including work of breathing, presence of amber or red features, diagnosis of bronchiolitis versus URTI/diagnostic uncertainty, duration of illness and presence of co-morbidities were noted. Outcomes were: safe discharge from PATCH service without adverse event and reattendance to emergency department, with discharge or with hospital admission.Results21 infants under 3 months were referred to PATCH via bronchiolitis referral form (12 being younger than 6 weeks). 11 had bronchiolitis based on clinical features/patient notes and 10 infants had URTI/diagnostic uncertainty. 16 (76%) were referred from PED, 5(24%) from inpatient/shortstay wards. Clinical characteristics of these infants is shown in Figure 1, outcomes in Figure 2.ConclusionsAlmost half of these young infants did not have definite bronchiolitis; the majority were discharged from PATCH after review(s) without adverse event. This small series suggests PATCH is helpful in the care of young infants with bronchiolitis (or possible bronchiolitis/URTI). These infants can be reviewed at home and discharged when improved, parental reassurance and education can be provided. There remains concern that young infants are at higher risk of apnoea/hypoventilation which can be difficult for families to recognize. Local guideline updates reflect that younger infants could be dis