543 - How Soon Can We Go Home? HFNC Discontinuation and Discharge Timing

Publication Number: 543.5185

Emily Bowen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Brittany Hunter, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: The use of high flow nasal cannula (HFNC) is increasingly used in treating acute respiratory illnesses. This widespread adoption of HFNC has been associated with prolonged length of stay (LOS). Extended observation following HFNC discontinuation may contribute to excess LOS. Little is known on optimal observation period following HFNC discontinuation to allow for safe discharge.

Objective: To investigate differences in LOS and hospital readmission between patients discharged within and after 12 hours of HFNC discontinuation.

Design/Methods: This was a retrospective analysis of children 1 month to 5 years of age admitted to a large, free-standing children’s hospital between January 2021 and August 2024. Previously healthy patients with a diagnosis of asthma, pneumonia, or bronchiolitis requiring HFNC support were included. Patients who required escalation to positive pressure ventilation (PPV) were excluded. Patient encounters were categorized as early discharge if discharged within 12 hours of HFNC discontinuation or late discharge if discharged after 12 hours from HFNC discontinuation. Primary outcomes included mean LOS and all-cause 3-day readmissions. Secondary outcomes included median length of treatment (LOT), median maximum flow rate, and median last flow rate. Data was extracted electronically from the electronic health record. Statistical analysis was performed using chi-square, Wilcoxon rank-sum, and t-tests.

Results: Of the 503 included encounters, there were 119 encounters in the early discharge group and 384 encounters in the late discharge group (Table 1). Patient characteristics including age and primary diagnosis did not differ significantly between groups. Mean LOS was significantly shorter in the early discharge group compared to the late discharge group (56.2 hours vs 89.9 hours, p<.001). There was no significant difference in 3-day all-cause readmissions (0 for early discharge vs. 3 for late discharge, p=.33). There was no significant difference between LOT, maximum flow rate, and last flow rate between the 2 groups.

Conclusion(s): Patients discharged within 12 hours from HFNC discontinuation experienced a significantly shorter LOS without an increase in hospital readmission. Prolonged observation periods following HFNC discontinuation may further contribute to the negative outcomes associated with increasing HFNC use and not be necessary. Standardized early discharge following HFNC discontinuation can support judicious HFNC use and improve high-value care delivery by minimizing unnecessary time in the hospital.

Table 1 Patient Characteristics


Table 1 Patient Characteristics