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James Todd, MD; David Bertoch, MHA; Susan Dolan, RN, MSN

Arch Pediatr Adolesc Med. 2002;156:1086-1090.

Objectives  To use a large national comparative database to measure the internal effect of a set of evidence-based bronchiolitis/viral pneumonia clinical care guidelines on clinical practice at a children's hospital, and to compare these changes with those at other children's hospitals.

Design  Prospective cohort study with retrospective and concurrent (other hospital) controls.

Setting  The Children's Hospital, Denver, Colo.

Participants  Hospitalized children with bronchiolitis and/or viral pneumonia.

Interventions  Our clinical guidelines focused on clear admission and discharge criteria, individualized transition-anticipating orders, and "prove it or don't use it" criteria for the use of respiratory syncytial virus testing, bronchodilators, chest physiotherapy, and ribavirin.

Main Outcome Measures  The effect of guideline implementation was determined by comparative measurement of internal changes in utilization and outcome (nosocomial infection rate) across time and by external comparison with other children's hospitals using standardized data from the Pediatric Health Information System database of the Child Health Corporation of America (Shawnee Mission, Kan).

Results  Overall, 10 636 bronchiolitis/viral pneumonia cases were studied: 1302 at the index hospital and 9334 at the 7 comparison hospitals. Internally, the index hospital's residents and attending physicians responded favorably to the bronchiolitis/viral pneumonia care guidelines, resulting in decreases in targeted resource utilization. There were no fatalities, and the number of days in the intensive care unit decreased even though the mean severity of admitted cases increased significantly. Targeted utilization was favorably affected, whereas untargeted utilization was not. Nosocomial infections did not increase with a decreased use of respiratory syncytial virus testing. The index hospital differed favorably from other children's hospitals in several categories.

Conclusion  Evidence-based care guidelines can successfully influence utilization and clinical outcome.

From the Department of Epidemiology, The Children's Hospital, Denver, Colo (Dr Todd and Ms Dolan); Child Health Corporation of America, Shawnee Mission, Kan (Mr Bertoch); and the Department of Pediatrics, Microbiology, and Preventive Medicine/Biometrics, University of Colorado School of Medicine (Dr Todd), Denver.

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