Acceptability of Deimplementing High-Flow Nasal Cannula in Pediatric Bronchiolitis

Area of Science:

• Pediatric critical care
• Health services research
• Implementation science

Background:

• High-flow nasal cannula (HFNC) use in pediatric bronchiolitis is widespread but lacks significant clinical outcome improvement.
• HFNC can increase healthcare costs and intensive care unit (ICU) utilization.
• Limited data exists on factors influencing the deimplementation of HFNC.

Purpose of the Study:

• To explore healthcare provider acceptability of HFNC deimplementation in children with bronchiolitis.
• To understand perceptions of HFNC benefits.
• To identify barriers and facilitators to HFNC deimplementation.

Main Methods:

• Quantitative survey data collection from healthcare providers.
• Semistructured interviews to supplement survey findings.
• Univariate statistical tests and thematic content analysis for data interpretation.

Main Results:

• 55% of providers felt positively about deimplementing HFNC, with increased positivity linked to greater familiarity with evidence.
• Physicians reported more positive feelings towards deimplementation than nurses or respiratory therapists.
• Barriers included discomfort with non-intervention and perceived HFNC benefits; facilitators included education and improved communication.

Conclusions:

• Deimplementation of HFNC for pediatric bronchiolitis is acceptable to healthcare providers.
• Hospital leaders should focus on staff education, fostering a culture of "safely doing less," and enhancing multidisciplinary communication.
• These strategies can facilitate the reduction of unnecessary HFNC use.