WIP 85 - Transforming Inter-Hospital Transfers: Evaluating the Impact of Updated Heated High Flow Transfer Guidelines on Outcomes for Infants with Bronchiolitis

Publication Number: WIP 85.7530

Julia E. Kozlowski, Children's Hospital Colorado, Denver, CO, United States; Paulina J. Ramos, Children's Hospital Colorado, Aurora, CO, United States; Jordan N. Wiesler, Children's Hospital Colorado, Denver, CO, United States; Brady Slater, Children's Hospital Colorado, Denver, CO, United States; Margot Johnson, University of Colorado School of Medicine, Denver, CO, United States; Benjamin A. Pallant, University of Colorado School of Medicine, Denver, CO, United States; Noah R. Mason, University of Colorado School of Medicine, Aurora, CO, United States; Michael J. Tchou, University of Colorado and Children's Hospital Colorado, Aurora, CO, United States; Gayle Soskolne, University of Colorado School of Medicine, Denver, CO, United States; Kimiko Dunbar, Children's Hospital Colorado, denver, CO, United States; Jillian Cotter, University of Colorado, Denver, CO, United States

Background: Community hospitals allow families to be close to home but sometimes do not have an intensive care unit (ICU). Thus, it is important to balance patient safety, transferring patients to hospitals with an ICU if they need it, while also avoiding unnecessary transfers that increase cost and inconvenience for families. Prior to 2023, our hospital policy was to transfer all infants < 6 months who required any amount of heated high flow nasal cannula (HHFNC), even if they looked well, to the affiliated quaternary care hospital, which was one hour away. Given that many of these transfers did not lead to escalation or ICU-level care, we analyzed data to identify risk factors for unnecessary transfers. This data demonstrated that infants < 3 months are at higher risk for needing ICU care compared to older infants; however, infants 3-6 months had no difference in need for positive pressure ventilation (PPV) compared to infants over 6 months. As a result of our previous study, in September 2023, the transfer criteria were modified to allow infants 3-6 months to stay at the community sites.

Objective: To evaluate the impact of the updated HHFNC transfer guidelines on patient outcomes and identify risk factors to inform future guideline modifications.

Design/Methods: This is a retrospective cohort study of infants 1-12 months admitted to our hospital network between 1/2021-11/2024 with a discharge diagnosis of bronchiolitis who received HHFNC. We excluded infants with complex chronic diseases and those directly admitted from the ED to ICU. The project will be submitted to our institution's quality improvement review board for approval. Our primary outcomes are the rates of inter-hospital transfer and ICU admissions. Secondary outcomes include length of stay and escalation to PPV or intubation. We will perform an interrupted time series with segmented regression analysis to compare outcomes before and after the changes to the transfer guidelines. We will also evaluate the association between risk factors, such as prematurity, asthma, and L/kg of flow on HHFNC, with escalation to PPV.