Value in Inpatient Pediatrics Network

Reducing the Use of Inhaled Short-Acting Bronchodilators in Children Hospitalized with Bronchiolitis

The lessons from this benchmarking were clear. There are certain centers who have developed the systems, structures and strategies that have allowed for delivery of evidence based care for the management of bronchiolitis-- in particular in reducing the misuse and overuse of bronchodilators and steroids.

The next step for the VIP Network was to sponsor a pilot "Collaborative" focused on creating a learning environment with a small group of organizations with the aim of disseminating best practices amongst each other and improve the quality of care for their patients.

The 1st Collaborative was Co-Chaired by Drs. Matt Garber and Beth Robbins

Specific AIM:
Reduce the use of inhaled short-acting bronchodilators in children hospitalized with bronchiolitis

To reduce the number of bronchiolitis patients treated with any bronchodilator medication by 20% from that institution’s baseline or to <=30%

To reduce the average total number of treatments per patient by 50% from that institution’s baseline

Elizabeth L. Robbins, Anne Arundel Medical Center
Jeanann P. Pardue MD, Director of CPG Inpatient Service East TN Children's Hospital
Michele Lossius, MD, FAAP Assistant Professor, UF-COM
Eric Balighian, Pediatric Hospitalist, St. Agnes Hospital
John A Pope MD, MPH, Physician Director, Pediatric Services, Scottsdale Healthcare Hospitals
Matthew Garber, MD,FAAP, FHM, Assistant Professor USC-SOM, Director Pediatric Hospitalists

1. a 17% overall DECREASE in the % of patients treated with >=1 bronchodilator
1. a 20% overall DECREASE in the # of bronchodilators/patient

Change Package:

A Respiratory Therapists Driven Protocol

Communication at every level – nurse, RT, PCP, ED attendings, other hospitalists, learners - is needed to address cultural barriers

New partnerships with RT, RN, IT, CQI, and administration are also needed to address technical barriers


Standardizing Respiratry Scoring Methods

This collaborative is expanding. We are seeking particpants willing to standardize the use of the same respiratory scoring system across mutliple hospitals. The chosen score is published under a separate tab on the website and is referred to as the Modified Cincinnatti score. Its was first published by CHMC Cincinnatti and has undergone one unpublished modification since inception. The score is employed in a "prove it or don't use it" approach to decreasing the overall use of bronchodilators. It may be used by nurses, respiratory therapists or physicians. Please email is you are interested in this collaborative.

Current Participants:

Michelle Marks, MD and Rita Pappas, MD; Cleveland Clinic

Michelle Lossius, MD; University of Florida

Matt Garber, MD; University of South Carolina

Shawn Ralston, MD; Unversity of Texas Health Science Ctr

Steve Narang, MD; Our Lady of the Lake, Baton Rouge


Getting to Zero for Steroids in Bronchiolitis

This collaborative is currently forming. We are seeking leadership and expertise in the area, with a specific aim of getting to zero on systemic steroid usage in bronchiolitis. Please email if you are interested in this collaborative.