Does stopping low-value bronchiolitis practices stick after two years?

Bronchiolitis is a common viral infection in infants that often leads to unnecessary tests and treatments. Research shows that hospitals can successfully stop these low-value practices, such as giving chest radiography, salbutamol, glucocorticoids, antibiotics, and epinephrine. A major study tracked these changes over time to see if the improvements lasted.

What the research says

In 2017, a large trial involving hospitals in Australia and New Zealand tested ways to improve bronchiolitis care. The intervention group stopped five specific low-value practices during the first 24 hours of hospitalization. This group achieved an 85.1% compliance rate with these new standards compared to the control group ².

The main question was whether these improvements would fade after the trial ended. Researchers followed the hospitals for two years using medical audits. They defined success as keeping the improvement in adherence at least 7% above the trial results. The study found that the better care patterns were sustained at the intervention hospitals two years after the trial completion ².

Other research supports using structured protocols to manage bronchiolitis more effectively. For example, a nurse-driven protocol for weaning high-flow nasal cannula support reduced therapy duration by 16 hours and shortened hospital stays by one day ⁴. Another study showed that a respiratory therapist and nurse weaning pathway also led to shorter stays in the pediatric intensive care unit ³.

What to ask your doctor

• What low-value tests or medications are currently being used for my child's bronchiolitis?
• Are there local hospital protocols that help avoid unnecessary chest X-rays or antibiotics?
• How does our hospital track adherence to evidence-based bronchiolitis care over time?
• What specific signs should we look for to know when it is safe to stop high-flow oxygen support?