Introduction

This quality standard covers the assessment, diagnosis and management of bronchiolitis in children. For more information see the bronchiolitis topic overview.

Why this quality standard is needed

Bronchiolitis is a condition that affects the lower respiratory tract. It is caused by infection with one of several different viruses. At the start of the infection, symptoms are usually those of a common cold, including a blocked or stuffy nose, cough and sneezing. After several days, breathing and feeding difficulties develop. Until this point, it is not possible to tell that the infection will cause bronchiolitis. If there are wheeze and/or crackles heard on clinical examination, a diagnosis of bronchiolitis can be made.

Bronchiolitis symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness. There are several individual and environmental factors that increase the risk of these severe illnesses in children with bronchiolitis. These include social deprivation, congenital heart disease, neuromuscular disorders, immunodeficiency and chronic lung disease.

Approximately 1 in 3 infants will develop clinical bronchiolitis in the first year of life, and 2–3% of these will need hospitalisation. In 2014/15 in England there were approximately 39,400 hospital admissions of children aged 0–4 with a primary diagnosis of bronchiolitis. Of these, around 93% (36,600) were aged under 1 year and around 7% (2,800) were aged 1–4 years[1].

Bronchiolitis can usually be managed at home by parents and carers. In most children bronchiolitis is mild, and breathing and feeding usually get better within 5 days. The cough may take longer to go (usually around 3–4 weeks).

The quality standard is expected to contribute to improvements in the following outcomes:

  • antibiotic use

  • parent and carer experience of primary and secondary care

  • hospital admissions.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and clinical effectiveness of care – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcome frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

3a Emergency admissions for acute conditions that should not usually require hospital admission

3b Emergency readmissions within 30 days of discharge from hospital*

Improvement areas

Preventing lower respiratory tract infections (LRTI) in children from becoming serious

3.2 Emergency admissions for children with LRTI

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

ii GP Out-of-hours services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to inpatients' personal needs

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

Improving access to primary care services

4.4 Access to i GP services

Alignment with Public Health Outcomes Framework

Indicators in italics in development

* Indicator is shared

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.11 Emergency readmissions within 30 days of discharge from hospital*

Alignment with NHS Outcomes Framework

* Indicator is shared

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to bronchiolitis in children.

Coordinated services

The quality standard for bronchiolitis in children specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole bronchiolitis care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to children with bronchiolitis.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality bronchiolitis service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating children with bronchiolitis should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting children with bronchiolitis. Healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.



[1] The Health and Social Care Information Centre (2015) Hospital Episode Statistics, Admitted Patient Care – England, 2014–15 [NS]