Applying the Evidence in Treatment of Acute Uncomplicated Bronchitis in Emergency Medicine

Studies demonstrate that 95% of acute uncomplicated bronchitis cases are viral in nature. Emergency medicine literature indicates that between 42.2% and 75% of patients diagnosed with acute, uncomplicated bronchitis are prescribed antibiotics. This is a healthcare concern, as the inappropriate use of antibiotic therapy is a major driver causing antibiotic resistance. Additionally, evidence-based guidelines are not supportive of radiological studies as a diagnostic modality for acute uncomplicated bronchitis. A review of literature including clinical care guidelines recommend the use of supportive care for the treatment of acute uncomplicated bronchitis. Specifically, the clinical care guidelines do not support antimicrobial therapy. Objectively, if normal vital signs are noted, with lack of adventitious breath sounds, clinical care guidelines do not support the use of radiological imaging. A Quality Improvement project was implemented at a large, urban emergency care center in the Upper Midwest. Multifaceted evidence-based education regarding the diagnosis of acute uncomplicated bronchitis and management was provided to emergency medicine providers staffing a large urban (Level III trauma center) emergency department. Data were collected from October 2014-Februray 2015 (N=90) this data were compared to data collected during the study period, of October 2015-Februray 2016 (N=49). Pre-intervention antibiotic prescription rate was 49.4%. Post intervention prescription rate was 8.2%, p<0.0001. A reduction in the number of radiological studies was noted to be from 90% to 67%, p=0.0021. The results of this study suggest that multifaceted brief educational sessions can be effective in the promotion and implementation of evidence-based care. Additional educational efforts to promote evidence-based care in the management of other acute conditions maybe successful using this model, and should be explored