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Nine Seasons of a Bronchiolitis Observation Unit and Home Oxygen Therapy Protocol
Author(s) -
Ohlsen Timothy J D,
Knudson Alexander M,
Korgenski E Kent,
Sandweiss David R,
Hofmann Michelle G,
Glasgow Tiffany S,
Coon Eric R
Publication year - 2021
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3576
Subject(s) - medicine , bronchiolitis , pediatrics , population , supplemental oxygen , oxygen therapy , emergency medicine , environmental health , respiratory system
BACKGROUND We implemented an observation unit and home oxygen therapy (OU‐HOT) protocol at our children's hospital during the 2010‐2011 winter season to facilitate earlier discharge of children hospitalized with bronchiolitis. An earlier study demonstrated substantial reductions in inpatient length of stay and costs in the first year after implementation. OBJECTIVE Evaluate long‐term reductions in length of stay and cost. DESIGN, SETTING, AND PARTICIPANTS Interrupted time‐series analysis, adjusting for patient demographic factors and disease severity. Participants were children aged 3 to 24 months and hospitalized with bronchiolitis from 2007 to 2019. INTERVENTION OU‐HOT protocol implementation. MAIN OUTCOME AND MEASURES Hospital length of stay. Process measures were the percentage of patients discharged from the OU; percentage of patients discharged with HOT. Balancing measures were 7‐day hospital revisit rates; annual per‐population bronchiolitis admission rates. Secondary outcomes were inflation‐adjusted cost per episode of care and discharges within 24 hours. RESULTS A total of 7,116 patients met inclusion criteria. The OU‐HOT protocol was associated with immediate decreases in mean length of stay (–30.6 hours; 95% CI, –37.1 to –24.2 hours) and mean cost per episode of care (–$4,181; 95% CI, –$4,829 to –$3,533). These findings were sustained for 9 years after implementation. Hospital revisit rates did not increase immediately (–1.1% immediate change; 95% CI, –1.8% to –0.4%), but a small increase in revisits was observed over time (change in slope 0.4% per season, 95% CI, 0.1%‐0.8%). CONCLUSION The OU‐HOT protocol was associated with sustained reductions in length of stay and cost, representing a promising strategy to reduce the inpatient burden of bronchiolitis.