Virtual Conference
Shaila Siraj

Shaila Siraj

Johns Hopkins All Children's Hospital, USA

Title: Reducing high-flow nasal cannula overutilization in viral bronchiolitis


Background: Heated high flow nasal cannula (HHFNC) therapy for bronchiolitis has become increasingly popular without evidence that this costly therapy impacts patient outcomes. Lack of criteria for appropriate may lead to overutilization, resulting in increased costs without patient benefit.

Objective: Our primary aim was to decrease use of HHFNC in mild to moderate bronchiolitis over one bronchiolitis season.

Design/Methods: Patients with Bronchiolitis < 2 years of age admitted to Hospital Medicine Service were included in this study. Using the model for improvement framework, we identified key drivers for HHFNC overuse and revised our bronchiolitis protocol to include LFNC trials prior to HHFNC initiation. We compared pre-intervention HHFNC utilization (December 2018 - April 2019) with postintervention HFNC utilization (December 2019 to March 2020). 

Results: One hundred ninety patients met inclusion criteria, 98 of them in the preintervention cohort and 92 in the post-intervention cohort. Overall, the median age was 9.1 months and 65% of patients were male. Our HHFNC utilization rate decreased from 62% (61/98) to 43% (40/92) in the post-intervention period. Our SPC analysis suggested special cause variation based on 8 points below the pre-intervention mean. Incremental cost per case declined from $84.15 pre-intervention to $59.20 postintervention.

Conclusions: Our QI intervention implementing a specified LFNC trial prior to the initiation of HHFNC shows promise in reducing overall HHFNC use. Future studies should focus on clear initiation and discontinuation criteria for HHFNC use in bronchiolitis.