Purpose Several studies have been unable to demonstrate a positive impact of practice guidelines on health care outcomes. We report the effect on hospital length of stay (LOS), costs, and 30-day readmission rates following the implementation of evidence-based (EB) guideline for oxygen (O2) discharge in infants < 2 years hospitalized with bronchiolitis.
Methods We developed an EB guideline for infants < 2 years hospitalized with bronchiolitis to standardize O2 discharge criteria within the hospital. The implementation occurred in 1998 and was coupled with presentation of data to clinicians regarding compliance with the guideline. To test the effectiveness of this strategy, we compared the preintervention control group (retrospective electronic medical records extraction of infants discharged from the hospital for bronchiolitis between 1994 and 1997) with the postintervention experimental group (prospective collection of data from children admitted to the hospital between 1998 and 2004). Unpaired student t-tests and chi-square test were used to calculate statistical significance between the groups.
Results There were 1,683 pre- and 2,553 postintervention admissions for bronchiolitis during the study period. The two groups were similar with respect to important clinical factors including severity of illness. Following the implementation of the guideline, the average LOS decreased significantly: 72.3 hours pre- versus 69.5 hours postintervention (p < .001). Thirty-day readmission rates were the same between the groups (4.16% pre vs 4.23% post, p = .91). Inflation-adjusted costs per case were also the same between the groups (p = .34).
Conclusions The implementation of an EB O2 discharge guideline coupled with feeding back compliance data to physicians resulted in a significant decreased LOS with no change in costs or readmission rates. Standardization of care provided by hospitalists can lead to efficient use of hospital resources and improvement in outcomes.
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