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Published on: August 7, 2017
Factors Influencing Feeding Decisions in Children With Bronchiolitis on High-Flow Nasal Cannula
Kristin A Shadman1, Claire A Rosenberger2, Laura P Chen1
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Feeding decisions for children with bronchiolitis on high-flow nasal cannula (HFNC) are influenced by child factors, care team experience, and institutional resources. Understanding these elements can help standardize care for pediatric patients on HFNC.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Healthcare systems engineering
Background:
- High-flow nasal cannula (HFNC) is frequently used in pediatric bronchiolitis cases.
- Lack of consensus on feeding recommendations leads to practice variability.
- Identifying factors influencing feeding decisions is crucial for optimizing care.
Purpose of the Study:
- To identify factors influencing feeding decisions for pediatric patients with bronchiolitis on HFNC.
- To explore perspectives from a national sample of interdisciplinary care team members.
- To understand the impact of hospital work systems on feeding practices.
Main Methods:
- Qualitative study using semi-structured virtual interviews.
- Conducted with nurses, respiratory therapists, speech-language pathologists, and physicians at 10 US hospitals.
- Content analysis of transcribed interviews guided by the Systems Engineering Initiative for Patient Safety 2.0 model.
Main Results:
- Eleven factors influencing feeding decisions were identified, categorized by the SEIPS model.
- Key factors include child/parent characteristics, care team experience, institutional guidelines, culture, and communication.
- Interviews highlighted the interplay between people, tools, organization, environment, task, and process.
Conclusions:
- Feeding decisions for pediatric bronchiolitis patients on HFNC are multifactorial.
- Factors include patient-specific elements, care team expertise, and institutional support systems.
- Findings can guide quality improvement initiatives to reduce practice variation.
Background And Objectives:
High-flow nasal cannula (HFNC) is used in up to 50% of children admitted with bronchiolitis. Consensus recommendations for feeding these children have not been established, and there is variability in practice. We sought to identify factors influencing feeding decisions for general care patients admitted with bronchiolitis on HFNC from a national sample of interdisciplinary care team members.
Methods:
In this qualitative study, we conducted semi-structured virtual interviews with care team members involved in making feeding decisions at 10 US hospitals from June 2022 to March 2023. Eligible participants included 1 nurse, respiratory therapist, speech language pathologist, and physician from each site. Interviews were audio-recorded, transcribed, and conducted until reaching sufficiency. Three researchers analyzed transcript data using content analysis guided by the Systems Engineering Initiative for Patient Safety 2.0 model.
Results:
We interviewed 29 participants, including 19 nurses, respiratory therapists, and speech language pathologists and 10 physicians. Participants identified 11 factors influencing feeding decisions related to hospital work systems and processes outlined in the Systems Engineering Initiative for Patient Safety model, including people (child and parent characteristics, care team experience), tools and technology (guideline, protocol, ordersets), organization (institutional culture, education), environment (time of day, care location), task (interventions to optimize feeding), and process (clinical assessment, feeding trial, communication).
Conclusions:
Our findings suggest that feeding decisions are driven by factors related to the child, care team experience, institutional tools, and culture. These key factors may inform local improvement efforts to decrease variation in feeding children with bronchiolitis requiring HFNC.
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