Pediatric Respiratory Care Pathways Improve Guideline Adherence in General Hospitals

A pragmatic cluster-randomized trial published in Pediatrics evaluated simultaneous implementation of inpatient pathways for pediatric asthma, pneumonia, and bronchiolitis in US general hospitals. From July 2022 to June 2024, 43 hospitals were randomized 1:1 to the intervention or waitlist control; investigators analyzed 11,760 admissions. Implementation combined audit and feedback, electronic order sets, iterative improvement cycles, and mentoring or facilitation. The primary outcome was mean composite adherence across seven evidence-based practices, with two or three assessed per diagnosis.

Compared with control, the intervention increased composite adherence by 9.9 percentage points (95% CI, 7.4–12.4), with significant improvements in four of seven individual practices. Intensive care transfers also decreased (adjusted odds ratio, 0.69; 95% CI, 0.54–0.89). There were no significant effects on length of stay or 30-day hospital readmission or emergency revisit.

These findings support implementing multiple respiratory care pathways together in general hospitals, where implementation barriers may differ from those in freestanding children’s hospitals. The primary endpoint measured care processes, although fewer intensive care transfers suggest potential clinical benefit. Only the abstract was available for this update; absolute transfer rates and details of individual practice changes were not provided.