Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community.

Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias Pub Date : 2023-02-01

David Andina Martínez, Rosa María Calderón Checa, Clara Ferrero García Loygorri, Yago Arnaiz Diumenjo, Raquel Porto Abal, Cristina Muñoz López, Ana Barrios Tascon, María Rodríguez Mesa, Diego Bautista Lozano, Almudena Lagares Velasco, María Belén Hernández Rupérez, Hemir David Escobar Pirela, Alberto Sánchez Calderón, Esther Casado Verrier, Carlos Rivas Crespo, Shaila Prieto Martínez, Sara Ruiz González, Belén Joyanes Abancens, María García Baro Huarte, María Ángeles García Herrero, Rebeca Villares Alonso, Sinziana Stanescu, Rubén Moreno Sánchez, Carmen Sara Gallego Fernández, Mercedes De la Torre Espi

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Abstract

Objectives: To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis.

Material and methods: Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started.

Results: A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001).

Conclusion: The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.

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通过减少使用未经推荐的药物，改善急诊科对急性支气管炎婴儿的护理：西班牙一个自治区的护理质量倡议。

目的评估在西班牙一个自治区的急诊科（ED）实施的护理质量改进计划的影响，该计划旨在减少在治疗急性支气管炎婴儿时使用未经推荐的药物：前后对比的准实验干预研究。我们回顾性地纳入了12个月或12个月以下的婴儿，他们因急性支气管炎于12月在西班牙国家卫生系统的24家医院急诊室接受治疗，这两个流行病时期分别为：2018年，实施该计划之前；2019年，实施该计划之后。收集的数据包括流行病学信息、临床和护理细节以及临床过程。该计划包括在流行期开始前提供信息资料和培训课程：共发现 7717 例病例（2018 年 4007 例，2019 年 2710 例）。两个时期的流行病学和临床特征没有差异。在这两个时期，ED 使用以下治疗方法的比例有所下降：沙丁胺醇从 2018 年的 29.4% （95% CI，28.8%-30.8%）降至 2019 年的 10.6%（95% CI，9.6%-11.6%）；肾上腺素从 6.0%（95% CI，5.3%-6.8%）降至 0.9%（95% CI，0.7%-1.3%）；高渗盐水从 8.2%（95% CI，7.3%-9.1%）降至 2.1%（95% CI，1.7%-2.6%）（P.001、所有比较）。出院时的沙丁胺醇处方从 38.7% (95% CI, 36.9%-40.4%) 降至 10.6% (95% CI, 9.6%-11.6%) (P.001)。入院率和再入院率没有变化，在急诊室花费的中位时间（四分位数间距）从 81（44-138）分钟降至 66（37-127）分钟（P.001）：护理质量改进措施能够减少急性支气管炎不推荐治疗干预的次数。然而，我们发现急诊室之间存在很大差异，这表明应继续开展培训并评估其影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias

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