WIP 67 - A High Flow Nasal Cannula Weaning Protocol as a Tool for Deimplementation

Publication Number: WIP 67.7547

Molly M. Stoddart, University of Kentucky College of Medicine, Lexington, KY, United States; Luke Heil, Kentucky Children's Hospital, Lexington, KY, United States; Emily Brereton, University of Kentucky, Lexington, KY, United States; Jennica Armstrong, University of Kentucky, Nicholasville, KY, United States; Rhea Vidrine, Kentucky Children's Hospital, Lexington, KY, United States

Background: Bronchiolitis is the leading cause of pediatric hospitalization of infants in the United States and usage of high flow nasal canula (HFNC), especially outside the ICU, is increasing. There is limited data that HFNC prevents intubation or significantly improves length of stay. Weaning protocols at some institutions have significantly cut down time on HFNC and decreased length of stay, thereby reducing cost and patient risk associated with prolonged hospitalization.
In 2022 the average length of stay for patients with bronchiolitis at Kentucky Children’s was 72 hours, while the national average was 60 hours. After evaluating the protocols of similar institutions, hospitalists, residents, and respiratory therapists collaborated to develop an institutional HFNC weaning protocol. Using quality improvement methodology, this protocol was implemented with the aim of reducing the length of stay.

Objective: The SMART aim is to reduce time on high flow nasal canula by 20% from a baseline of 47 hours to 38 hours for hospital patients < 24 months old with bronchiolitis March 2025 by implementing an RT driven HFNC weaning protocol. Our process metric is improving protocol compliance.

Design/Methods: Key drivers include utilization of the HFNC weaning protocol and team understanding of evidence-based bronchiolitis treatment. Protocol compliance, length of time on high flow and length of stay are monitored. Markers of protocol adherence include missed high flow weans, failure to document disease severity scores, and missed discontinuation opportunities. After one PDSA cycle, protocol adherence has improved with missed weans and severity scores decreasing from 16% to 10% and 25% to 15% respectively, but discontinuation opportunities, length of stay, and time on HFNC have not improved. After identifying barriers and noting no increase in PICU transfers or readmissions, the protocol has been altered to contain more aggressive weans and streamlined RT workflow. Data will be collected throughout this viral season and analyzed in March 2025 with project completion at that time.