Optimizing the Management of Pediatric Bronchiolitis: A Multi-cycle Clinical Audit at a Regional Hospital in Oman

Background Bronchiolitis is a major cause of lower respiratory tract infection and hospital admission among infants. Although international guidelines consistently recommend supportive care as the primary management approach, significant variation in clinical practice persists, often resulting in avoidable investigations, treatments, and healthcare expenditure, contributing to unnecessary costs and potential patient harm from avoidable interventions. Objective The objective of this study is to evaluate the effectiveness of a multi-cycle clinical audit in improving adherence to evidence-based bronchiolitis management guidelines at a regional hospital in Oman. Methods A sequential four-cycle clinical audit was carried out at Ibri Regional Hospital between March 2022 and October 2024. Audit standards were based on the 2014 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the diagnosis, management, and prevention of bronchiolitis. Following each cycle, targeted educational and feedback interventions were introduced, and subsequent changes in clinical practice were evaluated. Data were retrospectively extracted from electronic medical records (EMR) and assessed for trends in improvement across audit cycles. Results Across 210 admissions, the median patient age was six months (interquartile range: 3-10 months), and 85% were under 12 months of age. Over the four cycles, chest radiography (CXR) decreased from 82% (18/22) to 40.9% (27/66) (p<0.001), salbutamol use decreased from 91% (20/22) to 22.7% (15/66) (p<0.001), ipratropium bromide use decreased from 59% (13/22) to 9% (6/66) (p<0.001), corticosteroid use decreased from 31% (7/22) to 6.06% (4/66) (p<0.001), and antibiotic prescriptions decreased from 45% (10/22) to 15.1% (10/66) (p<0.001). Supportive care improved markedly: Intravenous (IV) fluids increased from 50% (11/22) to 92.4% (61/66) (p<0.001), and nasopharyngeal suctioning increased from 18% (4/22) to 98.4% (65/66) (p<0.001). Conclusion Sequential audit cycles with targeted educational interventions significantly improved adherence to evidence-based bronchiolitis management. This approach offers a feasible, replicable model for improving pediatric respiratory care in regional hospital settings.