Patient Selection
Included patients were to be aged 30-days to 23-months who are hospitalized with bronchiolitis (based upon ICD10 codes J21.0, J21.1, J21.8, J21.9) during the 16 weeks baseline (November 24, 2019 – March 14, 2020) and/or 16 weeks intervention (November 28, 2021 – March 19, 2022) periods.
Exclusion Criteria
Born <32 weeks gestational age, hemodynamically significant cardiac disease requiring cardiac medications (e.g., furosemide, beta blockers), Chronic lung disease (bronchopulmonary dysplasia) on home oxygen and/or diuretics, Significant neuromuscular disease requiring assistance with breathing or feeding, requires home oxygen or airway clearance support at baseline for any reason, Patient requiring CPAP, BiPAP or intubation during hospitalization, and those transferred from an outside facility.
Data Collection
Included patient charts were reviewed for the following information: age at presentation, sex, weight, emergency department length of stay (LOS), inpatient LOS, admitting unit (inpatient, pediatric intensive care unit), whether patient was started on HFNC, where patient was started on HFNC, total HFNC duration.
Measurement Grid
|
Type |
Name |
Definition |
Numerator |
Denominator |
Exclusion |
Data Source/Collection Tool |
Goal |
|
Outcome |
HFNC Initiation |
Reduce the proportoin of patients started on HFNC |
Patients started on HFNC |
All patients |
None |
Chart review/primary collection tool |
Reduce from baseline by 30% |
|
Outcome |
Hours of HFNC use |
Reduce total number of hours of HFNC treatment |
Total hours of HFNC |
All patients started on HFNC |
Patients not started on HFNC |
HFNC started time, HFNC end time (chart review)/primary collection tool |
Reduce from baseline by 30% |
|
Process |
HFNC Initiation Pause (HIP) |
Patients will have "HFNC Initiation Pause" implemented prior to HFNC initiation |
Patients that have HIP attempted prior to HFNC initiation |
All patients started on HFNC |
90% |
Monthly |
Goal 80% |
|
Process |
HFNC Holiday |
Patients will undergo HFNC rapid discontinuation trial |
Patients that have any Holiday attempt |
All patients treated with HFNC |
Patients not started on HFNC |
Holiday attempt (chart review)/primary collection tool |
Goal 80% |
|
Balancing |
ED LOS |
ED LOS not changed after introduction of HIP |
ED LOS (hours) |
All patients |
None |
ED LOS (EMR report or chart review)/primary collection tool |
No change |
|
Balancing |
Inpatient LOS |
Inpatient LOS not changed after interventions |
Inpatient LOS (hours) |
All patients |
None |
Inpatient LOS (EMR report)/primary collection tool |
No change |
|
Balancing |
Transfer for high level of care |
No change in rate of transfer to higher level of care |
# of children transferred to higher level to care (ICU, tertiary care setting) |
All patients admitted to inpatient ward |
Unit of admission is ICU |
Chart review/primary collection tool |
No change |