SAN DIEGO– Adoption of and strict adherence to a clinical pathway for diagnosis and treatment of bronchiolitis, especially in pediatric patients, can alleviate costs for both patients and hospitals in the ED and inpatient settings, and allow for shorter lengths of stay, according to a retrospective cohort study.
“This is an important topic because bronchiolitis is the leading cause of infant hospitalization in the U.S., and the cost of bronchiolitis hospitalization has been increasing,” Dr. Mersine A. Bryan of Seattle Children’s Hospital said at the annual meeting of the Pediatric Academic Societies.
“The care for bronchiolitis is supportive, meaning that testing and medical treatments are generally unnecessary, and can add to costs without improving outcomes. Because of that, bronchiolitis is a good candidate for clinical pathways and clinical practice guidelines,” Dr. Bryan said.
She and her coinvestigators looked at 282 children aged 0-24 months who presented at Seattle Children’s Hospital’s emergency department or inpatient setting with bronchiolitis between December 2009 and July 2012. A total of 18 process-of-care quality measures were instituted – 12 designed for inpatient care, 6 for emergency departments – with a primary objective of mitigating length-of-stay, costs, inpatient admission, and readmission. Pathways were meant to guide clinicians with “evidence-based recommendations and flows based on patient assessments and clinical findings.” Adherence to these pathways was scored by medical record review on a scale of 0-100 for each of the 18 categories. Low adherence was classified as a score below 86, midlevel adherence as a score between 86 and 93, and high adherence as anything above 94.
Mean adherence scores were: ED 78.2 (standard deviation [SD] 18.3, n = 279), inpatient 94.7 (SD 6.6, n = 231).No difference was noted in care of patients based on patient gender and medical complexity, but higher adherence was noted for younger patients.
Higher adherence led to shorter length of stay in both inpatient and emergency departments: 2.7 days vs. 3.7 days (P < .05), and 191 minutes vs. 264 minutes (P < .01), respectively. Mean patient costs saw greater reductions in departments with high adherence; a difference of $3,045 was noted in high-adherence inpatient departments, compared to a difference of $1,564 in inpatient departments with lower adherence to the pathway (P < .05). Similarly, emergency departments with high adherence saw average costs per patient drop by $183, compared to $95 for emergency departments with lower adherence scores (P < .05). Admittance odds and 7-day readmissions to emergency departments also were lower when adherence to pathways was higher.
Dr. Bryan cautioned that because this was a single-center study and the results may be difficult to generalize across institutions, adding that she and her coinvestigators were limited by the amount of information they could cull from available electronic medical records.
Dr. Bryan did not report any relevant financial disclosures.