Inpatient Pathway for Treatment of the Child with Bronchiolitis

Respiratory Assessment

Baseline Assessment and Pathway Status Determination

Respiratory Therapy will conduct their standard assessment after the child is admitted. The highest rating in any of the categories below dictates the patient's starting position on the pathway. A severe rating in any category would indicate a starting position in the Severe classification. All Moderate assessments, or a mix of Mild and Moderate would indicate a starting position in the Moderate classification. When in doubt, err on the side of classifying a patient as more severe.

    Mild (0) Moderate (1) Severe (2)
RR < 3 months 30-60 61-80 > 80
3 - < 12 months 25-50 51-70 > 70
1y – 2y 20-40 41-60 > 60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Oxygen Requirement None* Any Any
Suctioning Bulb Wall/Bulb Wall

*Any need for supplemental oxygen precludes Mild classification

Ongoing Respiratory Assessments

Severe Moderate Mild
Assess patient hourly Assess child every 2 hours Assess child every 4 hours
When 5 consecutive assessments over 4 hours are in the Moderate range, advance to the Moderate Pathway When 3 consecutive assessments over 4 hours are in the Mild range, advance to the Mild Pathway and begin discharge planning If symptoms do not increase after 4 hours, discharge