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| Title |
EFFECT OF HOSPITALISTS AND PRACTICE GUIDELINES
ON HOSPITALIZATION FOR RSV BRONCHIOLITIS |
| Author |
AM Harrison1, NM Boeing1, JB Domachowske2, RK
Kanter1 |
| Affiliation |
Department of Pediatrics, Divisions of Critical
Care1 and Infectious Disease2, SUNY Health Science Center at Syracuse |
| Introduction |
Respiratory syncytial virus(RSV) bronchiolitis
is the most common cause of wintertime pediatric hospitalization. Therapies with no proven
benefit are commonly used. Rational care is largely supportive (Arch Pediatr Adolesc Med.
1998;152:739-744). We sought to determine whether institution of a hospitalist service and
RSV practice guidelines shortened hospital stay and decreased therapies without proven
benefit. |
| Method |
A chart review of all patients with RSV admitted
to a regional pediatric referral center was performed. Study years were 1996-97(no
hospitalists, no guidelines) and 1997-98(hospitalists, guidelines). Starting in fall 1997,
some patients with RSV were cared for by generalists and some by hospitalists. |
| Result |
No differences were noted between study years
for age, sex, heart disease, bronchopulmonary dysplasia, immunodeficiency, prematurity,
respiratory failure, antibiotics, intravenous hydration, physician documentation of
response to albuterol, discharge on steroids, or readmission.
|
control(n=89) |
hospitalists & guidelines(n=82) |
| # albuterol nebs |
33± 41 |
13± 24* (*p<.05) |
| days on floor |
3.5± 3.2 |
2.6± 1.6* |
| d/c
on albuterol |
87%(77/89) |
55%(45/82)* |
In 1997-98, patients cared for by hospitalists(n=37) versus generalists(n=45) were more
likely to have physician documentation of response to albuterol (84% vs. 18%*), and were
less likely to receive a prescription for albuterol (19% vs. 84%*).
|
| Conclusion |
A hospitalist service and RSV practice
guidelines shortened hospitalization and decreased albuterol use in-hospital and at
discharge. These changes were more dramatic than those reported in a study of education
centered around guidelines (Arch Pediatr Adolesc Med. 1998;152:739-744). Hospitalists may
improve quality of care while using fewer resources. |
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