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Association between clinician team structure and continuous pulse oximetry overuse among infants hospitalized with

Andrew S Kern-Goldberger1,2, Jennifer A Faerber3, Rui Xiao4

  • 1Division of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.

Journal of Hospital Medicine
|August 9, 2026
PubMed

Insights

Continuous pulse oximetry (cSpO2) overuse in children with bronchiolitis was less common when residents, not attendings, provided frontline care. This finding suggests team structure impacts medical overuse.

Area of Science:

  • Pediatrics
  • Healthcare Management
  • Medical Overuse Research

Background:

  • Continuous pulse oximetry (cSpO2) monitoring for hospitalized children with bronchiolitis who do not require supplemental oxygen is recognized as a form of medical overuse.
  • Understanding factors contributing to medical overuse is crucial for improving healthcare efficiency and patient care.

Purpose of the Study:

  • To investigate whether the type of frontline clinician (resident physician vs. attending physician or advanced practice provider [APP]) influences the overuse of continuous pulse oximetry (cSpO2) in hospitalized children with bronchiolitis.
  • To analyze the association between clinician team structure and cSpO2 overuse during deimplementation and sustainment phases.

Main Methods:

  • Secondary analysis of the Eliminating Monitor Overuse (EMO) Trial (NCT05132322).
  • Compared cSpO2 overuse rates based on frontline clinician type: resident physicians, attending physicians, and APPs.
  • Utilized multivariable mixed-effects logistic regression on 4167 inpatient observations across 36 hospitals.

Main Results:

  • Residents provided frontline care in 61% of observations, attendings in 27%, and APPs in 10%.
  • Adjusted analyses revealed a 47% higher odds of cSpO2 overuse when attendings, compared to residents, delivered frontline care (aOR: 1.47; 95% CI: 1.12-1.93; p=0.01).
  • No significant difference in cSpO2 overuse was observed between APPs and residents.

Conclusions:

  • The likelihood of cSpO2 overuse in hospitalized children with bronchiolitis is associated with the frontline clinician's role.
  • Resident physician involvement in frontline care may help attenuate cSpO2 overuse compared to care led by attending physicians alone.
  • Findings suggest optimizing clinician team structure could be a strategy to reduce medical overuse in pediatric care.

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