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Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis
Courtney Benjamin Wolk1,2, Amanda C Schondelmeyer3,4,5, Frances K Barg6
1Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis offers no clinical benefit and increases resource use. Understanding factors contributing to overuse is key to reducing harms associated with cSpO2 in pediatric care.
Area of Science:
- Pediatric hospital medicine
- Implementation science
Background:
- Continuous pulse oximetry monitoring (cSpO2) in pediatric bronchiolitis patients is common but lacks evidence of improved clinical outcomes.
- cSpO2 overuse is linked to increased healthcare resource utilization and alarm fatigue, necessitating strategies for deimplementation.
Purpose of the Study:
- To identify barriers and facilitators to reducing cSpO2 overuse in children hospitalized with bronchiolitis.
- To inform deimplementation strategies for cSpO2 in pediatric bronchiolitis care.
Main Methods:
- A qualitative multicenter study involving semistructured interviews with 56 stakeholders (physicians, nurses, administrators, etc.) at 12 hospitals.
- Interviews were guided by the Consolidated Framework for Implementation Research to explore factors influencing cSpO2 use rates.
Main Results:
- Key facilitators for reducing cSpO2 overuse include strong leadership support, clear SpO2 guidelines integrated into electronic health records (EHRs), and consistent staff education.
- Individual clinician comfort and parental perceptions were identified as factors influencing cSpO2 practice patterns.
Conclusions:
- Deimplementation of cSpO2 for stable bronchiolitis patients requires clear protocols and EHR modifications.
- Targeted education for hospital staff on bronchiolitis management and the rationale for reducing cSpO2 is crucial for successful deimplementation.
Objective:
Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO2 overuse in order to reduce overuse and its associated harms.
Methods:
This multicenter qualitative study took place in the context of the Eliminating Monitor Overuse (EMO) SpO2 study, a cross-sectional study to establish rates of cSpO2 in bronchiolitis. We conducted semistructured interviews, informed by the Consolidated Framework for Implementation Research, with a purposive sample of stakeholders at sites with high and low cSpO2 use rates to identify barriers and facilitators to addressing cSpO2 overuse. Interviews were audio recorded and transcribed. Analyses were conducted using an integrated approach.
Results:
Participants (n = 56) included EMO study site principal investigators (n = 12), hospital administrators (n = 8), physicians (n = 15), nurses (n = 12), and respiratory therapists (n = 9) from 12 hospitals. Results suggest that leadership buy-in, clear authoritative guidelines for SpO2 use incorporated into electronic order sets, regular education about cSpO2 in bronchiolitis, and visual reminders may be needed to reduce cSpO2 utilization. Parental perceptions and individual clinician comfort affect cSpO2 practice.
Conclusion:
We identified barriers and facilitators to deimplementation of cSpO2 for stable patients with bronchiolitis across children's hospitals with high- and low-cSpO2 use. Based on these data, future deimplementation efforts should focus on clear protocols for cSpO2, EHR changes, and education for hospital staff on bronchiolitis features and rationale for reducing cSpO2.
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