570 - Using standardized respiratory support weaning protocols to improve length of stay and hospital cost in patients admitted with bronchiolitis
Saturday, April 26, 2025
2:30pm – 4:45pm HST
Publication Number: 570.7009
Benjamin Traisman, Rush Medical College of Rush University Medical Center, Glen Ellyn, IL, United States; Stephanie Lam, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Christina Chen, Rush Medical College of Rush University Medical Center, Chicago, IL, United States
Resident Rush Medical College of Rush University Medical Center Glen Ellyn, Illinois, United States
Background: High flow nasal cannula (HFNC) is an important intervention in the management of patients with bronchiolitis.1 Literature demonstrated a national average length of stay (LOS) of 2.5 days for patients admitted with bronchiolitis and a total healthcare financial burden of approximately $734 billion.3 Review of our institution’s data for patients admitted with bronchiolitis revealed an average LOS of 4.6 days. Given our longer LOS we aimed to develop a standardized approach to the weaning of oxygen therapy. We postulated this standardization would lead to a decrease in hospital LOS and overall hospital cost for bronchiolitis admissions. Objective: Our primary aim was to decrease hospital LOS by 20% in patients admitted with a diagnosis of bronchiolitis between January 2022 and June 2023 using a standardized weaning oxygen protocol. Our secondary aim was to decrease total hospital cost for patients admitted with bronchiolitis. Design/Methods: We created a multi-disciplinary task force of physicians, nurses, and respiratory therapists. Together, we developed a key driver diagram and cause and effect diagram. A standardized oxygen weaning protocol was developed by above mentioned stakeholders to meet our goals. We gathered data prior to initiation and after initiation of the protocol to review the impact of this intervention. Results: Data was extracted from our electronic health record(EHR). We evaluated the impact of the weaning protocol, using standard data analysis and review of a run chart. Average LOS prior to intervention was 4.6 days and after intervention average LOS was 3.5 days. There was overall regression towards the median after implementation of the protocol starting in January 2023. Hospitalization cost over this period showed a similar trend with an overall decrease and an improvement towards the median.
Conclusion(s): Using a multi-disciplinary approach and quality improvement methodology, we designed and implemented a standardized oxygen weaning protocol for patients admitted with bronchiolitis. We reduced our LOS from 4.6 days to 3.5 days, a 24% reduction, which achieved our goal during PDSA cycle 1. Challenges included protocol adherence and protocol awareness. We plan to address this in our ongoing second PDSA cycle with additional education for clinical staff and protocol access. Another interesting outcome was the reduction in hospitalization cost for these patients from $11,274 to $8,505. This data suggests that by focusing on LOS, we may also drive hospitalization costs down. Limitations include bronchiolitis seasonality and power of study due to the size of our pediatric facilities.
Key Drivers and Cause and Effect Diagram Fishbone_&_KeyDriversPAS.jpegInitial investigation into possible intervention
