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