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Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey
  1. Nusrat Homaira1,2,
  2. Louise K Wiles3,4,
  3. Claire Gardner3,
  4. Charlotte J Molloy3,
  5. Gaston Arnolda4,
  6. Hsuen P Ting4,
  7. Peter Damian Hibbert3,4,
  8. Jeffrey Braithwaite4,
  9. Adam Jaffe1,2
  1. 1 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Respiratory Department, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  3. 3 University of South Australia, Adelaide, South Australia, Australia
  4. 4 Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
  1. Correspondence to Professor Jeffrey Braithwaite, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia; jeffrey.braithwaite{at}


Background Bronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia.

Methods We searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013.

Results Purpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4).

Conclusions The study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.

  • clinical practice guidelines
  • compliance
  • quality measurement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors JB, PDH designed the overall study. AJ contributed to the design of the Bronchiolitis study. JB, PDH, GA, HPT and CJM carried out the collection and statistical analysis of the data. NH drafted the manuscript and was responsible for coordination of all aspects of the work. LKW and CG reviewed and made substantial contributions to earlier drafts. All authors made substantial contributions to the interpretation of results and writing of the final manuscript.

  • Funding This study was funded by National Health and Medical Research Council (grant no. APP1065898).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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