Reducing PICU-to-Floor Time-to-Transfer Decision in Critically Ill Bronchiolitis Patients using Quality Improvement...

Area of Science:

• Pediatrics
• Critical Care Medicine
• Respiratory Medicine

Background:

• Pediatric intensive care unit (PICU) pathways often lack specific de-escalation criteria for viral bronchiolitis.
• Variability in transfer preferences can lead to prolonged PICU stays for these patients.

Purpose of the Study:

• To decrease the time from achieving floor-appropriate heated high flow nasal cannula (HHF) settings to the transfer decision by 20% in pediatric patients with viral bronchiolitis.
• To standardize PICU-to-floor transfer assessment within a pediatric bronchiolitis cohort.

Main Methods:

• A pre- and post-intervention study design was used, including patients aged 6 months to 2 years with viral bronchiolitis, no comorbidities, and no intubation.
• The intervention involved introducing standardized transfer criteria and a readiness assessment protocol.
• Primary outcome: time from floor-appropriate HHF settings to transfer order; Secondary outcome: PICU length of stay.

Main Results:

• Median time-to-transfer decision significantly decreased from 14.4 hours to 7.8 hours (P < 0.001).
• The proportion of children transferred on ≥6 Lpm HHF increased from 51% to 72% (P < 0.001).
• No significant changes were observed in PICU length of stay or balancing measures like Rapid Response Team activation or readmissions.

Conclusions:

• Standardizing de-escalation criteria and transfer-readiness assessment effectively reduced transfer decision times for pediatric viral bronchiolitis patients.
• The intervention increased the utilization of appropriate HHF settings for transfers without adverse effects on patient safety or PICU resource utilization.