SCRATCH Trial: An Initiative to Reduce Excess Use of High-Flow Nasal Cannula

Area of Science:

• Pediatrics
• Respiratory Medicine
• Quality Improvement

Background:

• High-flow nasal cannula (HFNC) is frequently used for pediatric bronchiolitis.
• Unnecessary use of HFNC at lower flow rates can lead to increased healthcare costs and resource utilization.

Purpose of the Study:

• To reduce the unnecessary use of high-flow nasal cannula (HFNC) at lower flow rates.
• To implement a standard daily trial off HFNC for infants with bronchiolitis.

Main Methods:

• An interprofessional quality improvement collaboration developed and implemented interventions.
• The Simple Cannula/Room Air Trial for Children (SCRATCH Trial) was introduced as a standard trial off HFNC for eligible infants aged 1 month to 24 months.
• Process and outcome measures, including hours of HFNC treatment at ≤8 L per minute (LPM) and length of stay, were tracked.

Main Results:

• The mean hours of HFNC treatment at ≤8 LPM decreased from 36.3 to 16.8 hours post-implementation.
• The mean length of stay for patients decreased from 4.1 to 3.0 days.
• A total of 271 patients were included in the study (131 pre-implementation, 140 post-implementation).

Conclusions:

• The SCRATCH Trial was successfully implemented, leading to a significant reduction in HFNC use at lower flow rates.
• Rapid discontinuation of HFNC appears feasible and may be associated with a shorter length of stay in pediatric patients with bronchiolitis.