Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community

David Andina Martínez1, Rosa María Calderón Checa2, Clara Ferrero García Loygorri3, Yago Arnaiz Diumenjo4, Raquel Porto Abal5, Cristina Muñoz López6, Ana Barrios Tascon7, María Rodríguez Mesa8, Diego Bautista Lozano9, Almudena Lagares Velasco10, María Belén Hernández Rupérez11, Hemir David Escobar Pirela12, Alberto Sánchez Calderón13, Esther Casado Verrier14, Carlos Rivas Crespo15, Shaila Prieto Martínez16, Sara Ruiz González17, Belén Joyanes Abancens18, María García Baro Huarte19, María Ángeles García Herrero20, Rebeca Villares Alonso21, Sinziana Stanescu22, Rubén Moreno Sánchez23, Carmen Sara Gallego Fernández24, Mercedes De la Torre Espi1

Affiliation of the authors

1Emergency Department, Hospital Universitario Infantil Niño Jesús, Madrid, Spain. 2Emergency Department, Hospital Universitario 12 de Octubre, Madrid, Spain. 3Emergency Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 4Emergency Department, Hospital Universitario La Paz. Madrid, Spain. 5Emergency Department, Hospital Universitario Puerta de Hierro, Madrid, Spain. 6Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain. 7Emergency Department, Hospital Universitario Infanta Sofía, Madrid, Spain. 8Emergency Department, Hospital Universitario Infanta Cristina, Madrid, Spain. 9Emergency Department, Hospital Universitario de Getafe, Madrid, Spain. 10Emergency Department, Hospital Universitario Infanta Elena, Madrid, Spain. 11Emergency Department, Hospital Universitario del Sureste, Madrid, Spain. 12Emergency Department, Hospital Universitario Torrejón, Madrid, Spain. 13Emergency Department, Hospital Universitario del Henares, Madrid, Spain. 14Emergency Department, Hospital Universitario General de Villalba, Madrid, Spain. 15Emergency Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 16Emergency Department, Hospital Universitario de Fuenlabrada, Madrid, Spain. 17Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain. 18Emergency Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 19Emergency Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain. 20Emergency Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain. 21Emergency Department, Hospital Universitario de Móstoles, Madrid, Spain. 22Emergency Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. 23Emergency Department, Hospital Universitario del Tajo, Madrid, Spain. 24Emergency Department, Hospital El Escorial, Madrid, Spain.



Andina Martínez D, Calderón Checa RM, Ferrero García Loygorri C, Arnaiz Diumenjo Y, Porto Abal R, Muñoz López C, et al. Improving emergency department care of infants with acute bronchiolitis by reducing the useof unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community. Emergencias. 2023;35:31-8



To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis.


Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started.


A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P<.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P<.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P<.001).


The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.


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