Effect of point of care information on inpatient management of bronchiolitis

W James King^*¹^,3 , Nicole Le Saux^*¹ , Margaret Sampson^*² , Isabelle Gaboury^*² , Mark Norris^*¹ and David Moher^*¹^,2

¹Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

²Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

³Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada

author email corresponding author email* Contributed equally

BMC Pediatrics 2007, 7:4doi:10.1186/1471-2431-7-4


Published:	24 January 2007

Abstract

Background

We studied the effects of access to point-of-care medical evidence in a computerised physician order entry system (CPOE) on management and clinical outcome of children with bronchiolitis.

Methods

This was a before-after study that took place in a Canadian tertiary care paediatric teaching hospital. The intervention was a clinical evidence module (CEM) for bronchiolitis management, adapted from Clinical Evidence (BMJ Publishing Group) and integrated into the hospital CPOE. CPOE users were medical trainees under the supervision of staff physicians working in the infant ward. Use of antibiotics, bronchodilators and corticosteroids; disease severity; length of hospital admission; and trainee use and perception of the CEM were measured before and after CEM introduction.

Results

334 paediatric inpatients age 2 weeks to 2 years, with a clinical diagnosis of bronchiolitis; 147 children the year preceding and 187 children the year following introduction of a Clinical Evidence Module (CEM). The percentage of patients receiving antibiotics fell from 35% to 22% (relative decrease 37%) following the introduction of the CEM (p = 0.016). Bronchodilator use was high but following the CEM patients no longer received more than one variety. Steroid usage and length of hospitalisation were low and unaffected. Trainees found the CEM to be educational.

Conclusion

Readily accessible clinical evidence at the point of care was associated with a significant decrease in antibiotic use and an end to multiple bronchodilator use. The majority of physician trainees found the CEM to be a useful educational tool.