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De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative

Bronchiolitis is the most common cause for hospitalization in the first year of life, with hypoxemia and acute respiratory failure as major determinants leading to hospitalization. In addition, the lack of existing guidelines for weaning and discontinuing supplemental oxygen, including high-flow nas...

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Autores principales: Hoefert, Jennifer A., Molina, Adolfo L., Gardner, Hannah M., Miller, Kevin H., Wu, Chang L., Grizzle, Karisa, Miller, Kylee N., Orr, Mary M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8970083/
https://www.ncbi.nlm.nih.gov/pubmed/35369406
http://dx.doi.org/10.1097/pq9.0000000000000534
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author Hoefert, Jennifer A.
Molina, Adolfo L.
Gardner, Hannah M.
Miller, Kevin H.
Wu, Chang L.
Grizzle, Karisa
Miller, Kylee N.
Orr, Mary M.
author_facet Hoefert, Jennifer A.
Molina, Adolfo L.
Gardner, Hannah M.
Miller, Kevin H.
Wu, Chang L.
Grizzle, Karisa
Miller, Kylee N.
Orr, Mary M.
author_sort Hoefert, Jennifer A.
collection PubMed
description Bronchiolitis is the most common cause for hospitalization in the first year of life, with hypoxemia and acute respiratory failure as major determinants leading to hospitalization. In addition, the lack of existing guidelines for weaning and discontinuing supplemental oxygen, including high-flow nasal cannula, may contribute to prolonged hospitalization and increased resource utilization. METHODS: This single-center quality improvement initiative assessed the effect of implementing a standardized care process for weaning and discontinuing high-flow oxygen for patients hospitalized with bronchiolitis. Patients aged 1–24 months with bronchiolitis admitted to the general wards or ICU step-down unit from February 1, 2018, and January 31, 2020 were included in the study. Primary outcomes included length of stay and time on supplemental oxygen, with time on high-flow oxygen and length of time in ICU step-down unit as secondary outcomes. Balancing measures included transfer rate to Pediatric Intensive Care Unit, intubation rate, 7- and 30-day readmission rates, and 7- and 30-day ED visits after discharge. RESULTS: Following the standardized care process implementation, the mean length of stay decreased from 60.7 hours to 46.7 hours (P < 0.01). In addition, the mean time on any supplemental oxygen decreased by 47% (P < 0.01), the mean time on high-flow oxygen decreased by 45% (P < 0.01), and the mean time in the ICU step-down unit decreased by 27% (P =< 0.01). Balancing measures remained unchanged with no statistically significant differences. CONCLUSION: Implementing a standardized care process for weaning and discontinuing high-flow oxygen may reduce the length of stay and resource utilization for patients hospitalized with bronchiolitis.
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spelling pubmed-89700832022-04-01 De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative Hoefert, Jennifer A. Molina, Adolfo L. Gardner, Hannah M. Miller, Kevin H. Wu, Chang L. Grizzle, Karisa Miller, Kylee N. Orr, Mary M. Pediatr Qual Saf Individual QI projects from single institutions Bronchiolitis is the most common cause for hospitalization in the first year of life, with hypoxemia and acute respiratory failure as major determinants leading to hospitalization. In addition, the lack of existing guidelines for weaning and discontinuing supplemental oxygen, including high-flow nasal cannula, may contribute to prolonged hospitalization and increased resource utilization. METHODS: This single-center quality improvement initiative assessed the effect of implementing a standardized care process for weaning and discontinuing high-flow oxygen for patients hospitalized with bronchiolitis. Patients aged 1–24 months with bronchiolitis admitted to the general wards or ICU step-down unit from February 1, 2018, and January 31, 2020 were included in the study. Primary outcomes included length of stay and time on supplemental oxygen, with time on high-flow oxygen and length of time in ICU step-down unit as secondary outcomes. Balancing measures included transfer rate to Pediatric Intensive Care Unit, intubation rate, 7- and 30-day readmission rates, and 7- and 30-day ED visits after discharge. RESULTS: Following the standardized care process implementation, the mean length of stay decreased from 60.7 hours to 46.7 hours (P < 0.01). In addition, the mean time on any supplemental oxygen decreased by 47% (P < 0.01), the mean time on high-flow oxygen decreased by 45% (P < 0.01), and the mean time in the ICU step-down unit decreased by 27% (P =< 0.01). Balancing measures remained unchanged with no statistically significant differences. CONCLUSION: Implementing a standardized care process for weaning and discontinuing high-flow oxygen may reduce the length of stay and resource utilization for patients hospitalized with bronchiolitis. Lippincott Williams & Wilkins 2022-03-30 /pmc/articles/PMC8970083/ /pubmed/35369406 http://dx.doi.org/10.1097/pq9.0000000000000534 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI projects from single institutions
Hoefert, Jennifer A.
Molina, Adolfo L.
Gardner, Hannah M.
Miller, Kevin H.
Wu, Chang L.
Grizzle, Karisa
Miller, Kylee N.
Orr, Mary M.
De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title_full De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title_fullStr De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title_full_unstemmed De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title_short De-escalation of High-flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative
title_sort de-escalation of high-flow respiratory support for children admitted with bronchiolitis: a quality improvement initiative
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8970083/
https://www.ncbi.nlm.nih.gov/pubmed/35369406
http://dx.doi.org/10.1097/pq9.0000000000000534
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