Multicenter Quality Collaborative to Reduce Overuse of High-Flow Nasal Cannula in Bronchiolitis

Area of Science:

• Pediatrics
• Quality Improvement
• Respiratory Medicine

Background:

• High-flow nasal cannula (HFNC) use for bronchiolitis has increased significantly over the last decade.
• Evidence supporting the benefit of HFNC in bronchiolitis remains limited.
• This highlights a need for optimizing HFNC utilization in pediatric care.

Purpose of the Study:

• To decrease the initiation of high-flow nasal cannula (HFNC) by 30%.
• To reduce the duration of HFNC treatment by 30%.
• To evaluate the impact of a quality improvement collaborative on HFNC use in bronchiolitis.

Main Methods:

• A multi-hospital quality improvement collaborative was implemented.
• Hospitals were assigned to either reduce HFNC initiation (Pause) or treatment duration (Holiday).
• Interrupted time series and regression analyses were used to evaluate outcomes, with arms serving as controls.

Main Results:

• The Pause arm demonstrated a 32% unadjusted decrease in HFNC initiation, with a 23% reduction compared to controls.
• The Holiday arm showed a 28% unadjusted decrease in HFNC duration, with an 11-hour reduction compared to controls.
• Neither intervention led to an increase in length of stay.

Conclusions:

• The quality improvement collaborative effectively reduced both HFNC initiation and duration in bronchiolitis patients.
• The observed reductions were statistically significant and not attributable to secular trends.
• These findings support the implementation of targeted quality improvement initiatives to optimize HFNC use.