Overview
The purpose of this study is to identify the optimal deimplementation strategies for an overused practice: continuous pulse oximetry monitoring of children hospitalized with bronchiolitis who are not receiving supplemental oxygen.
Eligibility
Population 1a: Hospital staff who complete study questionnaires.
Inclusion Criteria:
- Nurse or physician fluent in English and employed full-time by the hospital, affiliated practice, or affiliated university who cared for bronchiolitis patients on a unit participating in the trial during at least 5 days of the most recent bronchiolitis season
- Hospital administrator fluent in English who oversaw the care of bronchiolitis on a local level (e.g. nurse manager) or a hospital level (e.g. Chief Quality and Safety Officer)
Exclusion Criteria:
• Under the direct supervision of study or site principal investigator(s)
Population 1b: Hospital staff who participate in qualitative interviews
In Aim 2, we will conduct semi-structured interviews with physicians and nurses who provide
care to bronchiolitis patients in participating units at the 5 hospitals with the highest
and 3 hospitals with the lowest sustainability (8 hospitals total; up to maximum of 8
interviews/hospital). Maximum anticipated enrollment 64.
Inclusion criteria:
- Nurses or Physicians who cared for bronchiolitis patients on a unit participating in
the trial during at least 5 days of the most recent bronchiolitis season
- Employed full-time by the hospital, affiliated practice, or affiliated university
- Fluent in English
Exclusion criteria:
• No exclusion criteria
Population 2a: Bronchiolitis patients directly observed while not receiving supplemental
oxygen ("in room air," for primary trial outcome)
Inclusion Criteria:
- Infants and children 2 months through 23 months old
- Hospitalized on non-ICU wards participating in the trial
- Cared for by generalist inpatient services (e.g. general pediatrics, hospital
medicine)
- Primary diagnosis of bronchiolitis in most recent physician progress note
- Not actively receiving supplemental oxygen ("in room air")
- Last documented receipt of supplemental oxygen >1 hour prior to direct observational
data collection
Exclusion Criteria:
- Documented apnea or cyanosis during the current illness
- Extreme prematurity (<28 weeks completed gestation)
- Cardiac disease
- Pulmonary hypertension
- Chronic lung disease
- Home oxygen requirement
- Neuromuscular disease
- Immunodeficiency
- Cancer
- Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19 / SARS-CoV-2)-related
illness (known or suspected, including multisystem inflammatory syndrome in children
multi-system inflammatory syndrome in children (MIS-C)
Population 2b: Bronchiolitis patients directly observed while receiving supplemental oxygen
(for underuse evaluation).
Inclusion Criteria:
- Infants and children 2 months through 23 months old
- Hospitalized on non-ICU wards participating in the trial
- Cared for by generalist inpatient services (e.g. general pediatrics, hospital
medicine)
- Primary diagnosis of bronchiolitis in most recent physician progress note
- Actively receiving ≥2 Liters/minute (2L/min) supplemental oxygen or 21% room air flow
Exclusion Criteria:
- Extreme prematurity (<28 weeks completed gestation)
- Cardiac disease
- Pulmonary hypertension
- Chronic lung disease
- Home oxygen requirement
- Neuromuscular disease
- Immunodeficiency
- Cancer
- Severe Acute Respiratory Syndrome Coronavirus 2 [Covid-19 / SARS-CoV-2 (known or
suspected)]
Population 3: Parents or guardians of bronchiolitis patients who participate in qualitative
interviews.
Inclusion Criteria:
- Their child was hospitalized for bronchiolitis on a unit participating in the trial
during the most recent bronchiolitis season
- Their child was found to be in room air during Aim 1 data collection
- Fluent in English
Exclusion criteria:
• They are an employee of the hospital or a hospital volunteer