BACKGROUND Studies have found infrequent interventions after croup admission. Our objectives were to achieve 25% reduction in (1) admission rate and (2) neck radiograph utilization among patients presenting to the emergency department. METHODS At our tertiary children's hospital, we implemented clustered interventions including education, guideline, and orderset integration. We included patients 3 months to 8 years old with an emergency department, observation, or inpatient encounter for croup. We excluded patients with direct or ICU admissions, complex chronic conditions, or concurrent asthma, pneumonia, or bronchiolitis. We reviewed a random sample of 60% of encounters from baseline (October 1, 2017 to September 30, 2019) and implementation (October 1, 2019 to September 30, 2020) periods. We conducted a posthoc analysis from October 1, 2017 to December 1, 2021 to assess sustainment during coronavirus disease 2019. Interrupted time series analysis was used to evaluate changes in outcome, process, and balancing measures. RESULTS There were 2906 (2123 baseline and 783 implementation) encounters included. Extrapolating preintervention trend estimates, the baseline admission rate of 8.7% decreased to 5.5% postintervention (relative decrease 37% [95% confidence interval: 8 to 66]) and sustained over 26 months after implementation. Admission rate in patients receiving 2 or fewer racemic epinephrine was significantly lower in implementation (1.7%) compared with baseline (6.3%), relative decrease of 72% (95% confidence interval: 68 to 88). There were no significant changes in neck radiographs, length of stay, or revisits. CONCLUSIONS Croup quality improvement interventions were associated with a significant decrease in hospital admissions with no increase in revisits.

中文翻译：

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使用临床指南和医嘱集来减少因哮吼而住院的人数。

背景 研究发现在哮吼入院后很少进行干预。我们的目标是在急诊科就诊的患者中（1）入院率和（2）颈部 X 光片使用率降低 25%。方法 在我们的三级儿童医院，我们实施了包括教育、指南和订单集整合在内的集群干预措施。我们纳入了 3 个月至 8 岁的患者，他们接受了急诊科、观察或因哮吼而住院。我们排除了直接或 ICU 入院、复杂慢性病或并发哮喘、肺炎或细支气管炎的患者。我们审查了从基线（2017 年 10 月 1 日至 2019 年 9 月 30 日）和实施（2019 年 10 月 1 日至 2020 年 9 月 30 日）期间的 60% 遭遇的随机样本。我们从 10 月 1 日开始进行事后分析，2017 年至 2021 年 12 月 1 日，以评估 2019 年冠状病毒病期间的持续性。中断时间序列分析用于评估结果、过程和平衡措施的变化。结果 包括 2906 次（2123 次基线和 783 次实施）遭遇。推断干预前趋势估计，基线入院率从 8.7% 下降到干预后的 5.5%（相对下降 37% [95% 置信区间：8 至 66]）并在实施后持续超过 26 个月。与基线 (6.3%) 相比，接受 2 种或更少外消旋肾上腺素的患者的入院率显着降低 (1.7%)，相对降低了 72%（95% 置信区间：68 至 88）。颈部 X 光片、住院时间或再访次数没有显着变化。