Traditional quality improvement efforts coupled with social psychology techniques resulted in improved guideline adherence in management of outpatient infants with bronchiolitis. This according to a recent quality improvement study that aimed to improve adherence to bronchiolitis guidelines from the American Academy of Pediatrics, which recommend against albuterol and corticosteroids for treating and chest radiographs (CRs) for diagnosing infants with bronchiolitis. The study was conducted in an urban academic pediatric primary care clinic caring for predominately minority and publicly insured children. Researchers tested provider guideline education, display of guidelines in patient care areas, and monthly e-mails to all providers documenting deviation rates, with individual e-mails to providers who deviated. They found:

• There were 380 children aged <2 years with a diagnosis of bronchiolitis in the 16 non-summer months pre-intervention and 417 in the 15 post-intervention months.
• Rates of prescribed and administered albuterol declined from 45.7% in the baseline period to 13.7% in the intervention period and CR use dropped from a mean of 10.1% to 3.4%.
• Steroid use did not change significantly.