• David Andina Martínez, Rosa María Calderón Checa, Clara Ferrero García Loygorri, Yago Arnaiz Diumenjo, Raquel Porto Abal, Cristina Muñoz López, Ana Barrios Tascon, María Rodríguez Mesa, Diego Bautista Lozano, Almudena Lagares Velasco, María Belén Hernández Rupérez, Hemir David Escobar Pirela, Alberto Sánchez Calderón, Esther Casado Verrier, Carlos Rivas Crespo, Shaila Prieto Martínez, Sara Ruiz González, Belén Joyanes Abancens, María García Baro Huarte, María Ángeles García Herrero, Rebeca Villares Alonso, Sinziana Stanescu, Rubén Moreno Sánchez, Carmen Sara Gallego Fernández, and Mercedes De la Torre Espi.
• Servicio de Urgencias, Hospital Universitario Infantil Niño Jesús, Madrid, España.
• Emergencias. 2023 Feb 1; 35 (1): 313831-38.

ObjectivesTo evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis.Material And MethodsBefore-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started.ResultsA total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001).ConclusionThe quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.

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