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Bronchiolitis
Dr. David TickellClinical Director, Women’s & Children’s Services
Ballarat Health Services
Clinical Director
What’s the point?
More work
Admin not clinical
Clinical Director
What’s the point?
More work
Admin not clinical
High numbers,lower acuity
The Big 5
SurgicalLRTI/URTIAsthmaGastroBronchiolitis
Bronchiolitis
No reduction in admissions in 20 yearsNo reduction in LOS despite oximetryNo fewer presentations despite smoking lessNo real treatment advances despite extensive research
So how do weCHANGEpractice
to improveoutcomes
?CPG
PracticeGuidelines
Protocols
Governancedocuments
We are hearingsome good questions
Are we overusing oximetry?
Can we avoid IV
fluids?
Is high flowbetter than sliced bread?
A prospective randomised trial comparing nasogastric with intrave hydration in children with bronchiolitis (protocol): the comparative rehydration in bronchiolitis study (CRIB).Paediatric Research in Emergency Departments International Collaborative1, Oakley E, Babl FE, Acworth J, Borland M, Kreiser D, Ne J, Theophilos T, Donath S, South M, Davidson A.
Large scale researchapplicable to our
children
PREDICTKnowledge translation and Australasian CPG
Large scale researchapplicable to our
children
PARISRCT for HFNP
Less escalation of care12% HFNP vs
23% low flow O2
No difference in SFX
No change in LOSNo change in time on O2
So… what’s next?
Real Time Audit
Start with apilot study…
Start with apilot study…
Start with apilot study…
Now for theReal Time audit…“Life QI”
Unwarranted tests & RxAdherence to CPGDischarge/admission rulesHigh flow analysisWe can even ask questions later
Thank youThe Benefit isCHANGE