Emergency Department Initiative to Decrease High-flow Nasal Cannula Use for Admitted Patients with Bronchiolitis

Area of Science:

• Pediatrics
• Emergency Medicine
• Respiratory Medicine

Background:

• High-flow nasal cannula (HFNC) is frequently used for mild to moderate (m/m) bronchiolitis despite limited evidence.
• The study addresses the overuse of HFNC in pediatric emergency departments (PEDs).

Purpose of the Study:

• To decrease HFNC utilization for m/m bronchiolitis in a PED from a baseline of 37% to under 18.5%.
• To implement and evaluate a clinical pathway for bronchiolitis management.

Main Methods:

• A multidisciplinary team developed and implemented a bronchiolitis pathway in December 2019.
• A respiratory score (RS) was integrated into the electronic medical record to objectively classify severity.
• Interventions included policy updates, RS application, order set modification, and HFNC-specific orders over four plan-do-study-act cycles.

Main Results:

• HFNC utilization for m/m bronchiolitis decreased from 37% to 17% between December 2019 and December 2021.
• RS entry increased from 60% to 73% during the intervention period.
• Sustained HFNC utilization rates were observed even with fluctuating patient volumes post-pandemic.

Conclusions:

• A standardized clinical pathway effectively reduces HFNC use in m/m bronchiolitis.
• Consistent use of a respiratory score, decision support, and education are key to sustained improvements in pediatric respiratory care.