Standardized Respiratory Weaning Protocol to Improve Bronchiolitis Length of Stay and Costs

Background and objectives High-flow nasal cannula (HFNC) is widely used in the management of bronchiolitis. However, variation in weaning practices may contribute to prolonged hospitalization. At our institution, the average length of stay (LOS) for bronchiolitis admissions was 3.54 days, exceeding the national average. We hypothesized that implementation of a standardized weaning protocol would reduce LOS and associated hospital costs. Our primary aim was to decrease hospital LOS by 20% among patients <24 months of age admitted with bronchiolitis over the course of one year. A secondary objective was to reduce mean total hospitalization costs over this same time period. Methods A multidisciplinary task force of physicians, nurses, and respiratory therapists applied Quality Improvement (QI) methodology to identify drivers of prolonged LOS. A standardized respiratory weaning protocol was developed and implemented. Process and outcome data were extracted from the electronic health record and analyzed using run charts. Inclusion criteria were patients admitted for primary diagnosis of bronchiolitis, <24 months of age, and treated with HFNC. Results Following implementation and optimization of protocol utilization, the average LOS decreased by 47%, and mean hospitalization cost decreased by 25.5%. Implementation of a standardized, multidisciplinary HFNC weaning protocol was associated with reduced LOS and hospitalization costs. Conclusions These findings support protocolized respiratory care as a key driver of high-value care in bronchiolitis management.