Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

Samah Awad; Rawan Hatim; Yousef Khader; Mohammad Alyahya; Nada Harik; Ahmad Rawashdeh; Walaa Qudah; Ruba Khasawneh; Wail Hayajneh; Dawood Yusef

doi:10.4081/mrm.2020.673

Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

Multidiscip Respir Med. 2020 Oct 9;15(1):673. doi: 10.4081/mrm.2020.673. eCollection 2020 Jan 28.

Authors

Affiliations

¹ Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
² Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
³ Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
⁴ Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington DC, USA.
⁵ Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Abstract

Introduction: Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan.

Methods: The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.

Results: Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5(2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).

Conclusion: We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians' behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.

Keywords: Bronchiolitis; Jordan; clinical practice guidelines; developing countries; implementation.

Grants and funding

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.