Empowering respiratory therapists to take a more active role in delivering quality care for infants with bronchiolitis.

BACKGROUND Cincinnati Children's Hospital Medical Center developed a bronchiolitis-treatment guideline and implemented a program, led by respiratory therapists, to encourage the use of respiratory function assessment to determine the need for and effect of bronchodilator treatment of infant bronchiolitis patients. METHODS The program was implemented on January 14, 2002, and included (1). a revised respiratory scoring form, (2). a change in the respiratory score threshold for a recommendation of bronchodilator treatment, (3). establishment of multidisciplinary rounds, (4). providing current data to the respiratory therapists, and (5). increasing effective data-based communication between the respiratory therapists and physicians. Guideline-eligible patients admitted before the implementation of the program (between 12/1/01 and 1/13/02) were compared to patients admitted during the program (between 1/14/02 and 3/31/02). We compared the mean numbers of bronchodilator treatments per patient in fiscal years 2001 and 2002. We defined "perfect respiratory care" as administration of bronchodilator only if preceded by suction treatment that resulted in a post-suction respiratory score >or= 3. RESULTS Documentation of respiratory scoring significantly increased following implementation of the program, as did "perfect respiratory care." Between the 2001 and 2002 bronchiolitis seasons, there was a decrease in both the mean number and the variability in the number of bronchodilator doses administered. CONCLUSIONS Expanding guideline recommendations to the level of specific protocols and empowering respiratory therapists to take a more active role improve the quality of care for infant bronchiolitis patients.