De-implementing low-value continuous pulse oximetry practice in infants hospitalized with bronchiolitis: A multicentre qualitative study
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Updated: Jul 11, 2025
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Published on: April 8, 2022
Brie Yama1,2, Gita Wahi3, Kim Zhou1,4
1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Implementing intermittent pulse oximetry in infants with bronchiolitis requires clear professional roles and communication. This change can reduce alarm fatigue and improve care transitions for better hospital quality improvement.
Area of Science:
- Pediatric Hospital Medicine
- Implementation Science
- Respiratory Care
Background:
- Clinical evidence supports intermittent pulse oximetry for stabilized infants with bronchiolitis.
- Continuous pulse oximetry is frequently used despite evidence favoring intermittent monitoring.
Purpose of the Study:
- To identify barriers and facilitators for de-implementing continuous pulse oximetry.
- To promote the implementation of intermittent pulse oximetry in hospitalized infants with bronchiolitis.
Main Methods:
- A multicentre qualitative study involving healthcare providers and caregivers of infants with bronchiolitis.
- Thematic analysis of interviews and focus groups, mapped to the Consolidated Framework for Implementation Research (CFIR).
Main Results:
- Healthcare provider roles and practice variations influenced monitoring decisions.
- Nurses recognized benefits of intermittent monitoring, including reduced alarm fatigue and workload.
- Clearer indications for continuous versus intermittent monitoring were identified by clinicians.
Conclusions:
- Clarifying professional roles and local practice standards is crucial for successful implementation.
- Supporting family understanding of pulse oximetry is essential for practice change.
- Findings can guide quality improvement initiatives to optimize monitoring practices in bronchiolitis care.
Background:
Clinical trial evidence supports the routine use of intermittent pulse oximetry in stabilized infants hospitalized with bronchiolitis. However, continuous pulse oximetry use is common.
Objective:
This study aimed to understand the barriers and facilitators to de-implement continuous pulse oximetry and implement intermittent pulse oximetry in infants hospitalized with stabilized bronchiolitis.
Methods:
This multicentre qualitative study interviewed attending pediatricians, residents, nurses, respiratory therapists, and caregivers of infants hospitalized with bronchiolitis at hospitals in Ontario, Canada, to explore beliefs, attitudes, and experiences regarding pulse oximetry use in bronchiolitis management. Data were analyzed using thematic analysis to understand barriers and facilitators to practice change, mapped to the Consolidated Framework for Implementation Research (CFIR) domains.
Results:
Sixty-seven participants from six hospitals were interviewed using individual interviews and focus groups. Healthcare providers emphasized the importance of identifying and understanding who is responsible for bedside pulse oximetry practice (physicians vs. nurses). Clinical experience, knowledge of guidelines, importance versus competing priorities, and the tensions among team members due to practice variation in monitoring, influenced monitoring practice. Nurses believed in the advantages of intermittent monitoring (reduced alarm fatigue, facilitation of timely discharges, and reduced workload). Clinicians identified ways to clarify indications for continuous monitoring (based on patient risk factors), versus indications to transition to intermittent monitoring (established oral feeding, sleeping without desaturations). Caregivers did not express a clear preference for monitoring type; rather, they described the need for clear communication around interpreting monitor readings, management decisions, and care transitions.
Conclusions:
Understanding professional roles, clarity around local practice standards and supporting families' understanding of pulse oximetry practice is essential for practice change. These findings may inform hospital quality improvement efforts to de-implement continuous monitoring in bronchiolitis hospital care.
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