O2112: Decreasing Bronchiolitis Length of Stay by Minimizing Practice Variation: A Multidisciplinary Quality Improvement Project

Purpose/Objectives: Bronchiolitis is one of the most common pediatric diagnoses requiring inpatient hospitalization. The AAP has released many recommendations to minimize unnecessary interventions and reduce the cost of care, but there is still significant clinical variation in management. Because of the high volume of patients with bronchiolitis, even small improvements in length of stay can have a significant impact on cost and throughput. The aim of this project was to minimize variation in bronchiolitis management in order to improve the length of stay without increasing the 72-hour readmission rate.

Design/Methods: We established a multidisciplinary team consisting of hospitalists, nurses, and respiratory therapists that met monthly. Our team tackled this project utilizing lean methodology and quality improvement principles. We audited patient charts, surveyed staff, and reviewed the literature to identify the most significant areas of clinical “waste,” and then we implemented PDSA cycles in rapid succession to address the most impactful areas of improvement. We utilized changes in the electronic medical record, physical fliers, structured educational sessions, and changes to the orientation process for new hires. We focused on adherence to a structured pathway to wean patients off of high flow nasal cannula, appropriate use of monitors, and early preparation of families for discharge. We obtained both subjective and objective data on process improvement metrics, and we shared our progress monthly to keep all staff engaged.

Results: From our baseline period (Aug 2021 - Dec 2022) to our intervention period (Jan 2023 – Dec 2023), we were able to decrease our average length of stay by 10.5 hours. Furthermore, we had an improvement in our percentage of patients discharged prior to 11am from 14% to 22%. Audits of compliance with the “room air trial” portion of our weaning protocol exhibited an improvement of 40% compliance at baseline to 75% compliance by the end of 2023. We also had a decrease in the 72-hour same-cause readmission rate from 0.7% to 0.0%.

Conclusion/Discussion: During 2023, our hospital had 1078 patients with bronchiolitis. Our length of stay improvements amounted to a total savings of 469 patient days over the year, equating to a potential capacity for an additional 183 patients. During a winter in which the hospital was at 100% capacity, this was crucial in allowing us to improve throughput to care for all of our patients. By involving hospitalists, nurses, and respiratory therapists throughout the hospital in these efforts, we were able to achieve large scale buy-in and sustain these efforts over a full year. Future PDSA cycles will involve testing faster weaning protocols, additional clinical decision support through the electronic medical record, and implementing processes to maintain these improvements.