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Nine Seasons of a Bronchiolitis Observation Unit and Home Oxygen Therapy Protocol
Timothy J D Ohlsen1, Alexander M Knudson2, E Kent Korgenski1
1Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, Utah.
Insights
The observation unit and home oxygen therapy (OU-HOT) protocol significantly reduced hospital stays and costs for bronchiolitis patients. These benefits were sustained long-term, offering a promising strategy for managing pediatric respiratory illness.
Area of Science:
- Pediatric hospital medicine
- Respiratory illness management
- Healthcare quality improvement
Background:
- Bronchiolitis is a common cause of pediatric hospitalization.
- Previous studies indicated short-term benefits of the OU-HOT protocol.
- Need to evaluate long-term impact on healthcare resource utilization.
Purpose of the Study:
- To assess the long-term effectiveness of the OU-HOT protocol.
- To evaluate sustained reductions in length of stay and cost for bronchiolitis patients.
- To analyze the impact on hospital revisit rates.
Main Methods:
- Interrupted time-series analysis of 7,116 children (3-24 months) hospitalized with bronchiolitis from 2007-2019.
- Implementation of an observation unit and home oxygen therapy (OU-HOT) protocol.
- Adjusted for patient demographics and disease severity, analyzing length of stay, cost, and revisit rates.
Main Results:
- The OU-HOT protocol led to immediate, sustained reductions in mean length of stay (-30.6 hours) and cost per episode (-$4,181) over 9 years.
- No immediate increase in 7-day hospital revisit rates was observed.
- A small, gradual increase in revisit rates over time was noted (0.4% per season).
Conclusions:
- The OU-HOT protocol demonstrates sustained efficacy in reducing length of stay and healthcare costs for pediatric bronchiolitis.
- This protocol is a viable strategy for decreasing the inpatient burden of bronchiolitis.
- Long-term monitoring of revisit rates is warranted.
Background:
We implemented an observation unit and home oxygen therapy (OU-HOT) protocol at our children's hospital during the 2010-2011 winter season to facilitate earlier discharge of children hospitalized with bronchiolitis. An earlier study demonstrated substantial reductions in inpatient length of stay and costs in the first year after implementation.
Objective:
Evaluate long-term reductions in length of stay and cost.
Design, Setting, And Participants:
Interrupted time-series analysis, adjusting for patient demographic factors and disease severity. Participants were children aged 3 to 24 months and hospitalized with bronchiolitis from 2007 to 2019.
Intervention:
OU-HOT protocol implementation.
Main Outcome And Measures:
Hospital length of stay. Process measures were the percentage of patients discharged from the OU; percentage of patients discharged with HOT. Balancing measures were 7-day hospital revisit rates; annual per-population bronchiolitis admission rates. Secondary outcomes were inflation-adjusted cost per episode of care and discharges within 24 hours.
Results:
A total of 7,116 patients met inclusion criteria. The OU-HOT protocol was associated with immediate decreases in mean length of stay (-30.6 hours; 95% CI, -37.1 to -24.2 hours) and mean cost per episode of care (-$4,181; 95% CI, -$4,829 to -$3,533). These findings were sustained for 9 years after implementation. Hospital revisit rates did not increase immediately (-1.1% immediate change; 95% CI, -1.8% to -0.4%), but a small increase in revisits was observed over time (change in slope 0.4% per season, 95% CI, 0.1%-0.8%).
Conclusion:
The OU-HOT protocol was associated with sustained reductions in length of stay and cost, representing a promising strategy to reduce the inpatient burden of bronchiolitis.
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