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

Michelle Noelck1, Alex Foster2, Serena Kelly2

  • 1Department of Pediatrics, Oregon Health and Science University, Portland, Oregon noelck@ohsu.edu.

Hospital Pediatrics
|March 23, 2021
PubMed

Insights

Implementing the Simple Cannula/Room Air Trial for Children (SCRATCH Trial) significantly reduced unnecessary high-flow nasal cannula (HFNC) use in infants with bronchiolitis. This quality improvement initiative also decreased patient length of stay.

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.
Abstract

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