Reducing Bronchodilators in Bronchiolitis

Bronchodilators in bronchiolitis

Bronchiolitis is a viral chest infection that affects infants under the age of one-year-old. It is the most common reason for infants to be admitted to hospital, particularly in winter. For bronchiolitis, there are no tests which can confirm or exclude the diagnosis and no treatments available, other than supportive care such as breathing support and fluids.

Why is it low-value care?

Salbutamol in bronchiolitis has not shown a benefit for any clinically significant outcomes such as oxygen saturation, hospital admission, length of stay or length of illness. The side effect profile including tachycardia, oxygen desaturation and tremors, means the harms outweigh the minimal benefits. All local and international guidelines recommend against using a bronchodilator in bronchiolitis.

Our recommendation is that bronchodilators are not used for any infant with bronchiolitis.

What were we doing?

Our baseline data from April 2016 to August 2018, showed we were using salbutamol in less than 10 per cent of infants with bronchiolitis.

What interventions did we introduce?

The Choosing Wisely campaign has introduced a prompt in our Electronic Medical Record (EMR) system that alerts clinicians when they try to order a bronchodilator that this is not best practice. We have combined this with an audit and feedback tool and education campaign for frontline clinicians.

How effective have we been?

At the end of this project, we achieved a rate of 3.6 per cent, exceeding our initial target of less than five per cent. We have now converted to a sustainability model to regularly monitor this rate and ensure it is maintained.

References and further reading (this could be collapsible)

https://evolve.edu.au/recommendations/pchd

Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews. 2014; 6:CD001266.

Lawrence JG, Andrew L, Bracken J, Voskoboynik A, Oakley E, South M, Middleton K, Scanlan B, Marshall T, Hiscock H. Bronchiolitis at a specialist paediatric centre: The electronic medical record helps to evaluate low-value care. J Paediatr Child Health. 2020 Feb;56(2):304-308