Elsevier

Journal of Clinical Virology

Volume 105, August 2018, Pages 84-87
Journal of Clinical Virology

Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline

https://doi.org/10.1016/j.jcv.2018.06.011Get rights and content

Highlights

  • The NICE bronchiolitis guideline led to modest but important improvements in care.

  • Full compliance with the guideline did not change; 18% in 2015 and 19% in 2017.

  • Fewer Trusts routinely test for respiratory viruses in bronchiolitic infants.

  • Cohorting policies vary considerably between Trusts.

Abstract

Background

Viral bronchiolitis is one of the most common causes of hospitalisation in young infants. It has previously been shown that many United Kingdom (UK) hospital Trusts were not compliant with many aspects of the National Institute for Health and Care Excellence (NICE) bronchiolitis guideline prior to its publication.

Objectives

This study aimed to investigate changes in the management of bronchiolitis by hospital Trusts between 2015 (before NICE guideline publication) and 2017, after publication.

Study design

We prospectively surveyed paediatricians at UK hospital Trusts on the management of bronchiolitis before (March to May 2015) and after (January to May 2017) the NICE bronchiolitis guideline publication in June 2015, using an electronic, structured questionnaire.

Results

In 2015 111 Trusts were represented and in 2017 100 Trusts. Significant improvements were seen in the use of nebulised bronchodilators and hypertonic saline and provision of parental written guidance. However, full compliance with the guideline did not change with 18% of Trusts compliant before publication of the guideline in 2015 and 19% fully compliant with the guideline in 2017.

Conclusions

Overall there were modest but important improvements in the reported management of bronchiolitis after the publication of the NICE guideline.

Section snippets

Background

Viral bronchiolitis results in up to 25,000 hospital admissions per year in England with a 15-fold variation in hospital admission rates between different NHS Trusts across England [1]. Individual differences in hospital management have been suggested as a contributory factor to this variation [2]. The National Institute for Health and Care Excellence (NICE) published the first national (English) bronchiolitis guideline in June 2015 [3] to try to reduce this variation in management. We have

Objectives

The aim of this study was to investigate changes in the management of bronchiolitis by hospital Trusts between 2015 (before NICE guideline publication) and 2017, after publication. In our previous study we had also investigated the use of respiratory virus testing and isolation/cohorting of infants with viral bronchiolitis by Trusts and thus a secondary aim of this study was to assess any changes in these practices. The data from the 2015 survey have been published previously [4].

Study design

A structured electronic questionnaire was sent to paediatricians from all Trusts in the UK that provide paediatric care (n = 170) between March to May 2015 and January to May 2017 as previously described [4]. It was sent as a link via e-mail to paediatric consultants and trainees working at each Trust. We compared the responses from Trusts in 2015 and 2017. How many of the same clinicians completed the survey in both years is not known as the survey was completed anonymously but 42 Trusts had a

Demographics

Of the 100 Trusts included in 2017, 75% were district general hospitals and 25% university hospitals. 99% of Trusts had an emergency department and 15% a paediatric intensive care unit (PICU). 50% of Trusts reported most children are initially seen by emergency doctors and 46% by paediatric doctors. Responses were obtained from 87 (87%) general paediatric consultants, four (4%) respiratory consultants and nine (9%) junior doctors. All respondents were involved in the management of infants with

Discussion

In this study we demonstrated modest but significant improvements in Trusts’ reported management of viral bronchiolitis after the publication of the NICE guideline. We have previously shown the NICE guideline resulted in similar modest improvements in the primary care management of bronchiolitis [6].

That only modest improvements are seen is not surprising given the relatively short time between the surveys, that there was already very high compliance in several areas and resistance to change

Funding

This study was funded by the Medical Sciences Division Medical Research Fund and the Jenner Institute of the University of Oxford. The funders had no role in the design, data collection or analysis, interpretation, write up or decision for article submission of the project.

Competing interests

AJP has previously conducted studies on behalf of Oxford University funded by vaccine manufacturers, but currently does not undertake industry funded clinical trials. AJP chairs the UK Department of Health’s (DH) Joint Committee on Vaccination and Immunisation (JCVI) and is a member of the World Health Organization’s (WHO) Strategic Advisory Group of Experts. The views expressed in this manuscript are those of the authors and do not necessarily reflect the views of the JCVI, the DH, or the WHO.

Ethical approval

As per the UK National Health Service (NHS) Health Research Authority guidance, formal ethical approval was not required for this study.

Acknowledgements

The authors acknowledge the support of the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and the NIHR Thames Valley and South Midlands Clinical Research Network. AJP is a NIHR Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. We thank all the doctors who completed the survey.

References (9)

  • E.J. Carande et al.

    Viral bronchiolitis management in hospitals in the UK

    J. Clin. Virol.

    (2018)
  • C.R. Cheung et al.

    Population variation in admission rates and duration of inpatient stay for bronchiolitis in England

    Arch. Dis. Child.

    (2013)
  • J. Murray et al.

    Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study

    PLoS One

    (2014)
  • National Institute for Health and Care Excellence

    Bronchiolitis: Diagnosis and Management of Bronchiolitis in Children. Clinical Guideline NG 9

    (2015)
There are more references available in the full text version of this article.

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