Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis. Akenroye, A. T., Baskin, M. N., Samnaliev, M., & Stack, A. M. Pediatrics, 133(1):e227--234, January, 2014. 00023 doi abstract bibtex OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS: We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS). RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by \$197 (95% CI: \$136 to \$259). Total cost savings was \$196,409 (95% CI: \$135,592 to \$258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge. CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.
@article{akenroye_impact_2014,
title = {Impact of a bronchiolitis guideline on {ED} resource use and cost: a segmented time-series analysis},
volume = {133},
issn = {1098-4275},
shorttitle = {Impact of a bronchiolitis guideline on {ED} resource use and cost},
doi = {10.1542/peds.2013-1991},
abstract = {OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED).
METHODS: We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).
RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23\% in CXR (95\% confidence interval [CI]: 11\% to 34\%), 11\% in RSV testing (95\% CI: 6\% to 17\%), 7\% in albuterol use (95\% CI: 0.2\% to 13\%), and 41 minutes in ED LOS (95\% CI: 16 to 65 minutes). Mean cost per patient was reduced by \$197 (95\% CI: \$136 to \$259). Total cost savings was \$196,409 (95\% CI: \$135,592 to \$258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.
CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.},
language = {eng},
number = {1},
journal = {Pediatrics},
author = {Akenroye, Ayobami T. and Baskin, Marc N. and Samnaliev, Mihail and Stack, Anne M.},
month = jan,
year = {2014},
pmid = {24324000},
note = {00023 },
keywords = {Anti-Bacterial Agents, Boston, Bronchiolitis, Emergency Service, Hospital, Female, Guideline Adherence, Health Resources, Hospital Costs, Hospitals, Pediatric, Humans, Inappropriate Prescribing, Infant, Male, Models, Statistical, Nurse's Practice Patterns, Outcome and Process Assessment (Health Care), Physician's Practice Patterns, Practice Guidelines as Topic, Quality Improvement, Regression Analysis, Retrospective Studies, Unnecessary Procedures},
pages = {e227--234}
}
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Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS: We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS). RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by \\$197 (95% CI: \\$136 to \\$259). Total cost savings was \\$196,409 (95% CI: \\$135,592 to \\$258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge. CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.","language":"eng","number":"1","journal":"Pediatrics","author":[{"propositions":[],"lastnames":["Akenroye"],"firstnames":["Ayobami","T."],"suffixes":[]},{"propositions":[],"lastnames":["Baskin"],"firstnames":["Marc","N."],"suffixes":[]},{"propositions":[],"lastnames":["Samnaliev"],"firstnames":["Mihail"],"suffixes":[]},{"propositions":[],"lastnames":["Stack"],"firstnames":["Anne","M."],"suffixes":[]}],"month":"January","year":"2014","pmid":"24324000","note":"00023 ","keywords":"Anti-Bacterial Agents, Boston, Bronchiolitis, Emergency Service, Hospital, Female, Guideline Adherence, Health Resources, Hospital Costs, Hospitals, Pediatric, Humans, Inappropriate Prescribing, Infant, Male, Models, Statistical, Nurse's Practice Patterns, Outcome and Process Assessment (Health Care), Physician's Practice Patterns, Practice Guidelines as Topic, Quality Improvement, Regression Analysis, Retrospective Studies, Unnecessary Procedures","pages":"e227--234","bibtex":"@article{akenroye_impact_2014,\n\ttitle = {Impact of a bronchiolitis guideline on {ED} resource use and cost: a segmented time-series analysis},\n\tvolume = {133},\n\tissn = {1098-4275},\n\tshorttitle = {Impact of a bronchiolitis guideline on {ED} resource use and cost},\n\tdoi = {10.1542/peds.2013-1991},\n\tabstract = {OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED).\nMETHODS: We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).\nRESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23\\% in CXR (95\\% confidence interval [CI]: 11\\% to 34\\%), 11\\% in RSV testing (95\\% CI: 6\\% to 17\\%), 7\\% in albuterol use (95\\% CI: 0.2\\% to 13\\%), and 41 minutes in ED LOS (95\\% CI: 16 to 65 minutes). Mean cost per patient was reduced by \\$197 (95\\% CI: \\$136 to \\$259). Total cost savings was \\$196,409 (95\\% CI: \\$135,592 to \\$258,223) over the 2 bronchiolitis seasons after guideline implementation. 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