Article thumbnail
Location of Repository

Evaluation of the effectiveness of a clinical pathway for bronchiolitis

By Joyce Louise Cheney


Objective: This study examines the use of a clinical pathway in the management of infants hospitalised with bronchiolitis. Study Design: A clinical pathway for the care of infants with bronchiolitis was developed from pathways used in tertiary paediatric institutions in Australia. 229 infants admitted to hospital with acute viral bronchiolitis and prospectively managed using a pathway protocol were compared with a retrospective analysis of 207 infants managed without a pathway in three regional and one tertiary hospital. Results: There were no differences between groups in demographic factors or clinical severity. The pathway had no effect on length of stay or time in oxygen. Readmission to hospital was significantly lower in the pathway group (P = 0.001). Administration of supplemental fluids (P = 0.001) and use of steroids was lower (P = 0.005) in the pathway group. Identification of parental smoking status was higher in the pathway group (P = 0.029). Data from the pathway demonstrated that boys were three times more likely to return to oxygen after weaning to air (OR = 3.30; 95%CI 1.39 - 7.81) after adjusting for admission oxygen saturation. Documentation of variances from the pathway was misunderstood by staff. Conclusions: A clinical pathway specifying local practice guidelines and discharge criteria can reduce the risk of readmission to hospital, the use of inappropriate therapies, and help with assessment of readiness for discharge

Topics: paediatrics, respiratory
Publisher: Queensland University of Technology
Year: 2005
OAI identifier:

Suggested articles


  1. (2003). A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. The New England
  2. (1999). Advising parents of asthmatic children on passive smoking: Randomised controlled trial.
  3. (1999). An evaluation of chest physiotherapy in the management of acute bronchiolitis.
  4. (2002). An evidence-based clinical pathway for bronchiolitis safely reduces antibiotic overuse.
  5. (2003). An integrated care pathway for burns.
  6. (1992). An introduction to critical paths.
  7. (1992). An unsuccessful cotinine-assisted intervention strategy to reduce environmental tobacco smoke exposure during infancy.
  8. (1999). Asthma clinical pathway: An interdisciplinary approach to implementation in the inpatient setting.
  9. (1997). Benchmarking and clinical pathway implementation on a multihospital basis.
  10. (2004). Bronchiolitis: Assessment and evidencebased management.
  11. (2001). Bronchodilators for bronchiolitis (cochrane review). The Cochrane Library(3),
  12. (2000). Care pathways: An evaluation of their effectiveness.
  13. (1993). Case management and caring behaviour.
  14. (2004). Clinical effectiveness of an integrated care pathway for infants with bronchiolitis.
  15. (1995). Clinical pathways and nursing practice in Australia. Unpublished
  16. (1997). Clinical pathways in subacute care settings.
  17. (1998). Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings.
  18. (1989). Collaborative care: Nursing case management.Chicago, IL: American Hospital Pub.
  19. (1993). Consensus view the management of acute bronchiolitis.
  20. (1999). Contemporary nursing issues, trends, and management.St Louis:
  21. (1998). Critical pathway for the emergency department management of acute asthma: Effect on resource utilization.
  22. (1995). Critical pathways as a strategy for improving care: Problems and potential.
  23. (1996). Critical pathways for collaborative nursing care.Menlo Park, Calif.: Addison-Wesley Nursing.
  24. (1997). Critical pathways: Effectiveness in achieving patient outcomes.
  25. (2004). Deconstructing clinical pathways: Mapping the landscape of health care.
  26. (1995). Developing clinically valid practice guidelines.
  27. (1997). Development of a scientifically validated coordinated care path.
  28. (1996). Dexamethasone in bronchiolitis: A randomised controlled trial.
  29. (1997). Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized controlled trial.
  30. (1988). Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. The New England
  31. (1994). Economic impact of viral respiratory disease in children.
  32. (1993). Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations.
  33. (1991). Effect of salbutamol on oxygen saturation in bronchiolitis.
  34. (2000). Effectiveness of a clinical pathway for inpatient asthma management.
  35. (2002). Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department.
  36. (1998). Effectiveness of a pneumonia clinical pathway: Quality and financial outcomes. Outcomes Management for Nursing Practice,
  37. (2001). Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis.
  38. (2004). Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: An example of client-centres communication.
  39. (1999). Evaluation of an evidence-based guideline for bronchiolitis.
  40. (1999). Freedom to practice - the development of patientcentred nursing.Oxford:
  41. (1998). Getting evidence into practice.
  42. (1996). Impact of a clinical pathway in the care of febrile infants.
  43. (2001). Impact of a pediatric asthma clinical pathway on hospital cost and length of stay.
  44. (1998). Impact of clinical pathways and practice guidelines on the management of acute exacerbations of bronchial asthma.
  45. (1999). Implementation of a clinical pathway decreases length of stay and cost for bowel resection.
  46. (1997). Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch / anal anastomosis.
  47. (2000). Implementation of evidence-based management of acute bronchiolitis.
  48. (1998). Implementing a clinical pathway for congestive heart failure: Experiences at a teaching hospital. Quality Management in Health Care,
  49. (2000). Improved outcomes for hospitalised asthmatic children using a clinical pathway.
  50. (2001). Inpatient care for uncomplicated bronchiolitis: Comparison with milliman and robertson guidelines.
  51. (2004). Is making smoking status a vital sign sufficient to increase cessation support actions in clinical practice?
  52. (1995). Issues in Australian nursing 5, the nurse as clinician.Melbourne: Churchill
  53. (1995). Leading and managing in nursing.St.
  54. (1995). Lung function, airway responsiveness, and respiratory symptoms before and after bronchiolitis.
  55. (1993). Making the commitment to managed care.
  56. (1996). Managing and understanding variances in clinical path mathodology: A case study.
  57. (2004). Medical - surgical nursing assessment and management of clinical problems
  58. (1993). Models of nursing care delivery and case management: Clarification of terms.
  59. (2002). National hospital cost data collection:Public Sector
  60. (2002). National hospital discharge survey:
  61. (2000). Outcome of respiratory syncytial virus infection and a cost-benefit analysis of prophylaxis.
  62. (1995). Outcomes of hospital-based managed care: A multivariate analysis of cost and quality.
  63. (2003). Outcomes research in pediatric settings: Recent trends and future directions.
  64. (1998). Outpatient tonsillectomy and adenoidectomy clinical pathways: An evaluative study. Pediatric Otolaryngology,
  65. (1999). Patient perceived quality-of-care in hospital in the context of clinical pathways: Development of an approach.
  66. (1996). Pediatric investigators collaborative network on infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.
  67. (2004). Perfecting practice guidelines.
  68. (2003). Pulse oximetry in bronchiolitis patients.
  69. (2000). Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis.
  70. (1989). Sample size for clinical and biological research.
  71. (1998). Sepsis evaluations in hospitalized infants with bronchiolitis.
  72. (1998). Smoking and smoking cessation among men whose partners are pregnant: A qualitative study.
  73. (1988). Smoking during pregnancy:National Health and Medical Research Council.
  74. (1998). Standardizing the care of bronchiolitis.
  75. (1993). The critical path method in stroke rehabilitation: Lessons from an experiment in cost containment and outcome improvement.
  76. (2004). The effect of an organisational model on the standard of care.
  77. (2000). The effects of a pediatric unilateral inguinal hernia clinical pathway on quality and cost.
  78. (1993). The effects of nursing models on quality of care.
  79. (1996). The next frontier in clinical pathways, the journey to outcomes management.
  80. (1987). Trial of an intervention to reduce passive smoking in infancy.
  81. (2003). Variations in bronchiolitis management between five new zealand hospitals: Can we do better?

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.