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Meeting ReportNeonatal/Pediatrics

High-Flow Nasal Cannula for Bronchiolitis Management: A Quality Improvement Project for Acute Care Transition

Brian J Smith, Blair Colwell, Michelle Hamline, Jia Xin Huang, Pranjali Vadlaputi, Jessica Witkowski, Heather McKnight, Sara Aghamohammadi, Shelli Beck, Kriston Reneau, Hadley Sauers-Ford and Heather Siefkes
Respiratory Care October 2020, 65 (Suppl 10) 3445231;
Brian J Smith
Respiratory Care, UC Davis, Yuba City, California, United States
Respiratory Care, Boise State University, Boise, Idaho, United States
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Blair Colwell
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Michelle Hamline
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Jia Xin Huang
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Pranjali Vadlaputi
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Jessica Witkowski
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Heather McKnight
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Sara Aghamohammadi
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Shelli Beck
Nursing, UC Davis, Sacramento, California, United States
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Kriston Reneau
Nursing, UC Davis, Sacramento, California, United States
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Hadley Sauers-Ford
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Heather Siefkes
Department of Pediatrics, UC Davis, Sacramento, California, United States
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Abstract

Background: Bronchiolitis is the leading cause of hospital admission for infants in the US and is commonly treated with HFNC. HFNC was not previously utilized in non-ICU wards at UC Davis Children’s Hospital. As part of an ongoing quality improvement (QI) effort, we identified the need to transition infants requiring HFNC for bronchiolitis out of the PICU.

Methods: In our single center QI project, we extended protocolized HFNC use to the acute care wards. A multidisciplinary team of physicians, nurses, respiratory therapists, and QI experts developed a HFNC protocol with an assessment tool; the Respiratory Assessment Classification (RAC). Preparing for safe deployment of protocolized HFNC in the non-ICU setting, we provided education for nurses, respiratory therapists, and physicians. QI meetings were held monthly and QI rounds daily to monitor adherence, implementation, outcomes, and adverse events. The pre-implementation period was December 2017 to March 2019, excluding December 2018 due to a short pilot program. The post-implementation period was March 2019 to February 2020. Analysis: Comparing pre and post groups, continuous variables (means or medians) were compared with t-test or STATA median test and categorical data (frequencies) were compared with X2 or Fisher’s exact test. IRB exemption was obtained through UC Davis.

Results: Patients were similar in both groups, however post implementation patients were older (10 vs 12 months mean, P=0.01). Following implementation, 73% of patients meeting out of ICU criteria were discharged home or transferred to the ward within 2 hours of meeting the criteria. Transferring to the ward while still receiving HFNC increased from 12% to 33% (P<0.001) in the post period. Patients in the post period had shorter ICU and hospital length of stay (LOS) than those in the pre period, by 12 hours and 1 day respectively (P < 0.001). Patients in the post period received oral feeds at higher HFNC flows than in the pre-period. Direct discharge from the PICU increased by 13% in our post-implementation group (P=0.05).

Conclusions: HFNC can be safely utilized outside of the ICU setting for the management of bronchiolitis. Standardization in care, education, and daily rounding leads to an increased focus in HFNC management in moderate to severe bronchiolitis. This may explain the increase in direct discharge from the ICU, as well as decreased hospital and ICU LOS. Our findings are encouraging and warrant future exploration in use of HFNC outside of the ICU setting.

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Respiratory Care
Vol. 65, Issue Suppl 10
1 Oct 2020
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High-Flow Nasal Cannula for Bronchiolitis Management: A Quality Improvement Project for Acute Care Transition
Brian J Smith, Blair Colwell, Michelle Hamline, Jia Xin Huang, Pranjali Vadlaputi, Jessica Witkowski, Heather McKnight, Sara Aghamohammadi, Shelli Beck, Kriston Reneau, Hadley Sauers-Ford, Heather Siefkes
Respiratory Care Oct 2020, 65 (Suppl 10) 3445231;

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High-Flow Nasal Cannula for Bronchiolitis Management: A Quality Improvement Project for Acute Care Transition
Brian J Smith, Blair Colwell, Michelle Hamline, Jia Xin Huang, Pranjali Vadlaputi, Jessica Witkowski, Heather McKnight, Sara Aghamohammadi, Shelli Beck, Kriston Reneau, Hadley Sauers-Ford, Heather Siefkes
Respiratory Care Oct 2020, 65 (Suppl 10) 3445231;
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