Bronchiolitis is a common lung infection in children and the leading cause of hospitalization in children under 2.
The Children’s Mercy Respiratory Outpatient Clinic provides 24/7 outpatient treatment for young infants who have been referred by their primary care provider following assessment and diagnosis of bronchiolitis.
Pediatric registered respiratory therapists provide respiratory assessments and airway clearance as well as educational resources with the goal of reducing hospital admissions and readmissions.
Therapists follow the hospital’s Bronchiolitis Care Process Model to assess and provide treatment.
Patrice Johnson, MBA, the Director of Respiratory Care at Children’s Mercy Kansas City, is here to explain The Children’s Mercy Respiratory Outpatient Clinic.
Selected Podcast
Respiratory Outpatient Clinic: A Proactive Approach to Reducing Bronchiolitis Admissions
Featured Speaker:
Patrice Johnson
Patrice Johnson, MBA, RRT-NPS, is the Director of Respiratory Care at Children’s Mercy Kansas City. Patrice is a registered respiratory therapist specializing in neonatal and pediatric care. She holds a Master of Business Administration degree with a concentration in Health Care Administration. Patrice also holds Green Belt Certification in Lean/Six Sigma Body of Knowledge. Transcription:
Respiratory Outpatient Clinic: A Proactive Approach to Reducing Bronchiolitis Admissions
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “A Proactive Approach to Reducing Bronchiolitis Admissions.” My guest is Patrice Johnson. Mrs. Johnson is the Director of Respiratory Care at Children’s Mercy Kansas City. Mrs. Johnson, welcome to the show.
Mrs. Patrice Johnson (Guest): Thank you so much for having me today.
Dr. Smith: We know that bronchiolitis is a pretty common infection in children. How many children are affected by it each year?
Mrs. Johnson: It is estimated that about a third of all children will have bronchiolitis in their first two years of life. It’s the most common cause of admission to the hospital for infants during their first year. In the U.S., it is estimated to be about a hundred thousand admissions annually. What we know is that bronchiolitis is caused by a viral lower respiratory tract infection. It is characterized by acute inflammation, an edema of the epithelial cells of the small airways and also an increase in mucous production. There is no specific treatment for the viral infection. For many of our children, the viral process will run its course in one to two weeks and is self-limiting. But for some children--infants under the age of two--the illness can be much more severe. We’ve looked to the American Academy of Pediatrics to establish clinical practice guidelines for diagnosis, management and prevention of bronchiolitis. Additionally, Children’s Mercy Hospital has collaborated with a multi-disciplinary group to develop an outpatient clinical practice guideline for bronchiolitis. That can be found on our website at ChildrensMercy.org, the evidenced-based practice or clinical practice guidelines. For many of the children, they just need supportive care and can be managed at home - hydration, antipyretic as needed, clearing their secretions with a bulb syringe and good hand washing. But for some of our children, they need additional support which includes oxygen and nasogastric or intravenous fluids. Then there is a set of patients who need more help with suctioning and managing their secretions but yet, they don’t need the advances of the hospital and that’s the group who we have focused on.
Dr. Smith: So, let’s run through, specifically, some of the services that you provide, focusing on the ones you think are really making that impact to reduce hospital admissions because of bronchiolitis.
Mrs. Johnson: Absolutely. The respiratory out-patient clinic, we call it “The ROC,” is staffed by pediatric respiratory therapists. The therapists are there as a partner for our providers both from the hospital and especially those providers in our community. The providers make their diagnosis of bronchiolitis and refer their patients to the clinic. The clinic is open 24 hours a day, 7 days a week which provides convenient access for the families any time of the day or night. We are open November through April, which is the typical season for bronchiolitis in our region. When a patient comes into the clinic, we start with an assessment of that patient. We utilize an intake form and we also utilize a bronchiolitis scoring tool prior to performing any suction interventions as well as post intervention. There are three components of the tool including retraction, respiratory rate and breath bounds. We also ask about hydration and fever. We assess the oxygen status using pulse oximetry and if the patient does score an elevated score of five or greater, we discuss having that infant assessed further by a physician as that patient may require additional care or admission. During the visit, we will utilize nasal aspiration and nasopharyngeal suctioning, if needed. We always like to use the least invasive device to clear the secretions first and then progress to the more invasive as needed. Following the assessments and intervention, then we have time to spend on educating the family. We provide education on their child’s bronchiolitis illness, how to use a bulb syringe and we also talk about passive smoking. Because we are in a clinic setting and not a busy emergency department or an urgent care, we’re able to spend more time going over the information and really taking the time to answer any questions that they have. Families have really found this to be very helpful and it is surprising how many people do not understand the impact of smoking and what that can have on the infants, especially infants who are experiencing a respiratory illness.
Dr. Smith: Mrs. Johnson, when you look at the whole program you have been up and running, I think, since 2014; what kind of impact have you seen – and not just on hospital admissions, but also just on the total patient parent experience with bronchiolitis?
Mrs. Johnson: Our first season gave us a great opportunity to really see what that might be for us. We had a tremendous reception by our community and by our providers. We had over 1600 referrals and we had 1150 visits. With that, we saw the ability to help patients get discharged sooner. We saw patients who would come and see us and really gave us some great feedback. The nice part about our clinic is that our average wait time for the patients was 41 minutes, which, as you can imagine, ERs and urgent cares are much longer than that. For most of our families, they only needed to access the clinic once or maybe twice during their seven day prescription time. At the end of the season, we surveyed families and providers to see, really, did we meet their needs. We received some fantastic feedback from the families who really appreciated the service as well as the therapist’s time in reviewing suctioning and really reassuring them and alleviating their fears. For many of our families, they’ve not experienced a child with respiratory illness before and watching their child having difficulty breathing is really scary. We really felt like we were able to work with that family and help them through that difficult time for them. We had one family who brought their baby in for suctioning a couple of times in the evening and they did so to help clear the thick mucus and secretions prior to the baby going to bed at night. They really felt that the baby benefitted and was able to get through those couple of very challenging nights better and they didn’t have to go to an emergency room or an urgent care. Our providers were also gracious enough to give us feedback and it was also very positive. We had a community pediatrician that said they were very thankful to have the respiratory outpatient clinic; that several of their families had used the clinic and were thankful they had somewhere to go when they needed some extra help. Our hospitalists also appreciated the clinic being available for families. When they were discharging patients from the hospital, it allowed the families to be at home instead of in the hospital, but yet there was still a resource available to them. We really have had a tremendous appreciation for the clinic to meet the needs of those families who didn’t really need to be in the hospital.
Dr. Smith: It really sounds like, Mrs. Johnson, that your program, the proactive approach that Children’s Mercy is taking here really could be a model for many other pediatric hospital centers throughout the country. I want to thank you, Mrs. Johnson, for the work that you are doing and thank you for coming on the show. You are listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.
Respiratory Outpatient Clinic: A Proactive Approach to Reducing Bronchiolitis Admissions
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “A Proactive Approach to Reducing Bronchiolitis Admissions.” My guest is Patrice Johnson. Mrs. Johnson is the Director of Respiratory Care at Children’s Mercy Kansas City. Mrs. Johnson, welcome to the show.
Mrs. Patrice Johnson (Guest): Thank you so much for having me today.
Dr. Smith: We know that bronchiolitis is a pretty common infection in children. How many children are affected by it each year?
Mrs. Johnson: It is estimated that about a third of all children will have bronchiolitis in their first two years of life. It’s the most common cause of admission to the hospital for infants during their first year. In the U.S., it is estimated to be about a hundred thousand admissions annually. What we know is that bronchiolitis is caused by a viral lower respiratory tract infection. It is characterized by acute inflammation, an edema of the epithelial cells of the small airways and also an increase in mucous production. There is no specific treatment for the viral infection. For many of our children, the viral process will run its course in one to two weeks and is self-limiting. But for some children--infants under the age of two--the illness can be much more severe. We’ve looked to the American Academy of Pediatrics to establish clinical practice guidelines for diagnosis, management and prevention of bronchiolitis. Additionally, Children’s Mercy Hospital has collaborated with a multi-disciplinary group to develop an outpatient clinical practice guideline for bronchiolitis. That can be found on our website at ChildrensMercy.org, the evidenced-based practice or clinical practice guidelines. For many of the children, they just need supportive care and can be managed at home - hydration, antipyretic as needed, clearing their secretions with a bulb syringe and good hand washing. But for some of our children, they need additional support which includes oxygen and nasogastric or intravenous fluids. Then there is a set of patients who need more help with suctioning and managing their secretions but yet, they don’t need the advances of the hospital and that’s the group who we have focused on.
Dr. Smith: So, let’s run through, specifically, some of the services that you provide, focusing on the ones you think are really making that impact to reduce hospital admissions because of bronchiolitis.
Mrs. Johnson: Absolutely. The respiratory out-patient clinic, we call it “The ROC,” is staffed by pediatric respiratory therapists. The therapists are there as a partner for our providers both from the hospital and especially those providers in our community. The providers make their diagnosis of bronchiolitis and refer their patients to the clinic. The clinic is open 24 hours a day, 7 days a week which provides convenient access for the families any time of the day or night. We are open November through April, which is the typical season for bronchiolitis in our region. When a patient comes into the clinic, we start with an assessment of that patient. We utilize an intake form and we also utilize a bronchiolitis scoring tool prior to performing any suction interventions as well as post intervention. There are three components of the tool including retraction, respiratory rate and breath bounds. We also ask about hydration and fever. We assess the oxygen status using pulse oximetry and if the patient does score an elevated score of five or greater, we discuss having that infant assessed further by a physician as that patient may require additional care or admission. During the visit, we will utilize nasal aspiration and nasopharyngeal suctioning, if needed. We always like to use the least invasive device to clear the secretions first and then progress to the more invasive as needed. Following the assessments and intervention, then we have time to spend on educating the family. We provide education on their child’s bronchiolitis illness, how to use a bulb syringe and we also talk about passive smoking. Because we are in a clinic setting and not a busy emergency department or an urgent care, we’re able to spend more time going over the information and really taking the time to answer any questions that they have. Families have really found this to be very helpful and it is surprising how many people do not understand the impact of smoking and what that can have on the infants, especially infants who are experiencing a respiratory illness.
Dr. Smith: Mrs. Johnson, when you look at the whole program you have been up and running, I think, since 2014; what kind of impact have you seen – and not just on hospital admissions, but also just on the total patient parent experience with bronchiolitis?
Mrs. Johnson: Our first season gave us a great opportunity to really see what that might be for us. We had a tremendous reception by our community and by our providers. We had over 1600 referrals and we had 1150 visits. With that, we saw the ability to help patients get discharged sooner. We saw patients who would come and see us and really gave us some great feedback. The nice part about our clinic is that our average wait time for the patients was 41 minutes, which, as you can imagine, ERs and urgent cares are much longer than that. For most of our families, they only needed to access the clinic once or maybe twice during their seven day prescription time. At the end of the season, we surveyed families and providers to see, really, did we meet their needs. We received some fantastic feedback from the families who really appreciated the service as well as the therapist’s time in reviewing suctioning and really reassuring them and alleviating their fears. For many of our families, they’ve not experienced a child with respiratory illness before and watching their child having difficulty breathing is really scary. We really felt like we were able to work with that family and help them through that difficult time for them. We had one family who brought their baby in for suctioning a couple of times in the evening and they did so to help clear the thick mucus and secretions prior to the baby going to bed at night. They really felt that the baby benefitted and was able to get through those couple of very challenging nights better and they didn’t have to go to an emergency room or an urgent care. Our providers were also gracious enough to give us feedback and it was also very positive. We had a community pediatrician that said they were very thankful to have the respiratory outpatient clinic; that several of their families had used the clinic and were thankful they had somewhere to go when they needed some extra help. Our hospitalists also appreciated the clinic being available for families. When they were discharging patients from the hospital, it allowed the families to be at home instead of in the hospital, but yet there was still a resource available to them. We really have had a tremendous appreciation for the clinic to meet the needs of those families who didn’t really need to be in the hospital.
Dr. Smith: It really sounds like, Mrs. Johnson, that your program, the proactive approach that Children’s Mercy is taking here really could be a model for many other pediatric hospital centers throughout the country. I want to thank you, Mrs. Johnson, for the work that you are doing and thank you for coming on the show. You are listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.