Bronchiolitis Care: Implementing an Inpatient Pediatric Protocol

BACKGROUND: Bronchiolitis is the main cause of hospitalization for children under two years old. There is disagreement among providers about which evidence-based care to be used for these patients, leading to unnecessarily prolonged inpatient stays and inconsistent patient experiences.

LOCAL PROBLEM: On the pediatric floor of a West Tennessee hospital, there are no established treatment protocols or guidelines for caring for patients admitted with bronchiolitis. The purpose of my evidence-based practice improvement project was to implement a bronchiolitis protocol for children under the age of two who were admitted to an acute care pediatric unit, thereby standardizing care for bronchiolitis patients within this unit.

METHODS: The Evidence-Based Practice Improvement (EBPI) was the selected model for implementing a bronchiolitis protocol. Using PDSA cycles, nasal suctioning, reducing blood tests and chest radiography, and deploying nasogastric feeding tubes and intravenous catheters were monitored over three months during the peak of bronchiolitis season.

INTERVENTIONS: Education and a process change map based on evidence-based practice guided the outcome, process, and balancing measures implemented during the project. The length of stay before and after project implementation were measured as outcomes, along with the percentage of staff and provider compliance with protocol recommendations for treatment.

RESULTS: The average length of stay for bronchiolitis patients decreased by 2 hours and 15 minutes, and transfers to higher acuity facilities reduced from 7% to 4% from 2024 to 2025. There was also a decline in lab work and chest-rays from 48% to 36%. There was not a 100% compliance with interventions by staff.

CONCLUSIONS: Implementing a nurse-led bronchiolitis protocol, while not statistically significant, was clinically significant in reducing the overall patient length of stay and transfers to higher levels of care. The plan for sustainability involves providing staff with the bronchiolitis treatment tool and encouraging physician compliance.