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Clinical Outcomes of Bronchiolitis After Implementation of a General Ward High Flow Nasal Cannula Guideline
Jeffrey Riese1, Timothy Porter2, Jamie Fierce2
1Rhode Island Hospital/Hasbro Children's Hospital, Department of Pediatrics, Providence, Rhode Island; and jriese@lifespan.org.
Insights
Implementing a high-flow nasal cannula (HFNC) guideline for infants with bronchiolitis increased HFNC use but did not significantly change hospital length of stay or other key clinical outcomes.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Health Services Research
Background:
- Bronchiolitis is a common respiratory infection in infants.
- High-flow nasal cannula (HFNC) therapy is increasingly used for respiratory support.
- Guidelines for HFNC use on general pediatric wards are being developed.
Purpose of the Study:
- To evaluate the impact of a new ward-based high-flow nasal cannula (HFNC) guideline on clinical outcomes for infants with bronchiolitis.
- To assess changes in length of hospital stay, PICU transfer rates, and readmission rates after guideline implementation.
Main Methods:
- Retrospective, pre-post intervention study with interrupted time series analysis.
- Inclusion of 1937 infants admitted with bronchiolitis between 2010 and 2014.
- Comparison of outcomes 24 months before and after HFNC guideline initiation on general wards.
Main Results:
- HFNC use for bronchiolitis increased from 23.9% to 35.2% after guideline implementation (P < .001).
- No significant changes were observed in total hospital length of stay (P = .48).
- No significant differences in PICU length of stay (P = .06), PICU transfer rate (P = .97), intubation rate, or 30-day readmission.
Conclusions:
- A ward-based HFNC guideline successfully increased the utilization of HFNC for infants with bronchiolitis.
- The guideline did not lead to significant improvements in hospital length of stay or other measured clinical outcomes.
- Further research may be needed to optimize HFNC use and its impact on pediatric respiratory care.
Objective:
The goal of this study was to assess the association of the introduction of a ward's high-flow nasal cannula (HFNC) guideline with clinical outcomes of infants with bronchiolitis.
Methods:
We conducted a retrospective, pre-post intervention study with an interrupted time series analysis of infants admitted with bronchiolitis between 2010 and 2014 at an urban, tertiary care children's hospital. Patients admitted in the 24 months before and after initiation of a guideline for HFNC use on the general wards were compared. The primary outcome was length of hospital stay. Secondary outcomes were PICU transfer rate and length of stay, intubation rate, and 30-day readmission, adjusted for season.
Results:
A total of 1937 patients met inclusion criteria; 936 were admitted before and 1001 admitted after the introduction of HFNC use on the general wards. Comparing the 2 groups, the hospital-wide rate of HFNC use in bronchiolitis treatment increased after HFNC became available on the wards (23.9% vs 35.2%; P < .001). The ward's HFNC guideline was not associated with a change in preintervention trajectory of total hospital length of stay (P = .48), PICU length of stay (P = .06), or rate of PICU transfer (P = .97). There was also no difference in intubation rate or 30-day readmission between the 2 groups.
Conclusions:
Initiating a guideline for HFNC use on the general pediatric wards was associated with an increase in the use of the intervention with no significant change in total hospital length of stay, PICU length of stay and transfer rate, intubation rate, or 30-day readmission for patients with bronchiolitis.
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