Study: new clinical guidelines result in significant decrease in hospital admissions for croup

A recent study to evaluate the quality and outcomes of new clinical guidelines for treating croup in kids determined most patients who need two or fewer doses of racemic epinephrine can be safely discharged from the emergency department. This is a new treatment recommendation for many pediatric care providers. These clinical guidelines for croup were first developed in 2018 by Children’s Minnesota.  

Dr. Gabrielle Hester, medical director of the department of value and clinical excellence and pediatric hospitalist at Children’s Minnesota, recently published a report about the study, “Use of a Clinical Guideline and Orderset to Reduce Hospital Admissions for Croup,” in Pediatrics.

“The goal of the study was to determine if a cluster of interventions to improve care for patients with croup was effective in safely reducing hospital admission,” said Dr. Hester. “The study found by following the clinical guidelines, approximately 60 patients per year with croup seen at Children’s Minnesota can safely avoid hospital admission.”  

Using interrupted time series analysis, the research team determined this guideline resulted in a decreased admission rate from 8.7% to 5.5%, which was sustained for more than 26 months after implementation. There was no change in readmission. The admission rate in patients receiving two or fewer racemic epinephrine was significantly lower in implementation (1.7%) compared with baseline (6.3%). 

The study implemented clustered interventions including education, guideline and order set integration for patients 3 months to 8 years old with an emergency department, observation, or inpatient encounter for croup. 

In addition to the croup clinical guidelines, Children’s Minnesota has created more than 25 other clinical guidelines for health care professionals to use when caring for their patients. These resources provide evidence-based guidelines that will apply to the bulk of patients with a given condition and should be adapted based on clinical judgement and individual situations.