Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis

Pediatric Research in Inpatient Settings (PRIS) Network

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

OBJECTIVE: Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO2 overuse in order to reduce overuse and its associated harms. METHODS: This multicenter qualitative study took place in the context of the Eliminating Monitor Overuse (EMO) SpO2 study, a cross-sectional study to establish rates of cSpO2 in bronchiolitis. We conducted semistructured interviews, informed by the Consolidated Framework for Implementation Research, with a purposive sample of stakeholders at sites with high and low cSpO2 use rates to identify barriers and facilitators to addressing cSpO2 overuse. Interviews were audio recorded and transcribed. Analyses were conducted using an integrated approach. RESULTS: Participants (n = 56) included EMO study site principal investigators (n = 12), hospital administrators (n = 8), physicians (n = 15), nurses (n = 12), and respiratory therapists (n = 9) from 12 hospitals. Results suggest that leadership buy-in, clear authoritative guidelines for SpO2 use incorporated into electronic order sets, regular education about cSpO2 in bronchiolitis, and visual reminders may be needed to reduce cSpO2 utilization. Parental perceptions and individual clinician comfort affect cSpO2 practice. CONCLUSION: We identified barriers and facilitators to deimplementation of cSpO2 for stable patients with bronchiolitis across children's hospitals with high- and low-cSpO2 use. Based on these data, future deimplementation efforts should focus on clear protocols for cSpO2, EHR changes, and education for hospital staff on bronchiolitis features and rationale for reducing cSpO2.

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalJournal of Hospital Medicine
Volume16
Issue number1
DOIs
StatePublished - Jan 2021

Funding

We acknowledge the NHLBI scientists who contributed their expertise to this project as part of the U01 Cooperative Agreement funding mechanism as federal employees conducting their official job duties: Lora Reineck, MD, MS, Karen Bienstock, MS, and Cheryl Boyce, PhD. We thank the Executive Council of the Pediatric Research in Inpatient Settings (PRIS) Network for their contributions to the early scientific development of this project. The Network assessed a Collaborative Support Fee for access to the hospitals and support of this project. We thank the PRIS Network collaborators for their major contributions to data collection measuring utilization to identify the hospitals we subsequently chose for this project. We thank Claire Bocage and the Mixed Methods Research Lab for major help in data management and data analysis. Disclosures: Dr Schondelmeyer discloses additional grant funding from the Agency for Healthcare Research and Quality (AHRQ) and from the Association for the Advancement of Medical Instrumentation. Dr Brady discloses additional grant funding from the AHRQ. Dr Bettencourt discloses additional funding from the National Heart, Lung, and Blood Institute (NHLBI) and the National Clinician Scholars Program. Dr Bonafide discloses additional grant funding from the NHLBI, AHRQ, and the National Science Foundation for research related to physiologic monitoring. Dr Beidas receives royalties from Oxford University Press and has provided consultation to Merck and the Camden Coalition of Healthcare Providers. The other authors have no conflicts of interest to disclose. Funding: Research reported in this publication was supported by a Cooperative Agreement from the NHLBI of the National Institutes of Health (NIH) under award number U01HL143475 (Bonafide, PI). As a Cooperative Agreement, NIH scientists participated in study conference calls and provided ongoing feedback on the conduct and findings of the study. Dr Schondelmeyer's effort contributing to this manuscript was in part funded by the AHRQ under award number K08HS026763. Dr Brady's effort contributing to this manuscript was in part funded by the AHRQ under award number K08HS23827. The funding organizations had no role in the design of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH or AHRQ. Disclosures: Dr Schondelmeyer discloses additional grant funding from the Agency for Healthcare Research and Quality (AHRQ) and from the Association for the Advancement of Medical Instrumentation. Dr Brady discloses additional grant funding from the AHRQ. Dr Bettencourt discloses additional funding from the National Heart, Lung, and Blood Institute (NHLBI) and the National Clinician Scholars Program. Dr Bonafide discloses additional grant funding from the NHLBI, AHRQ, and the National Science Foundation for research related to physiologic monitoring. Dr Beidas receives royalties from Oxford University Press and has provided consultation to Merck and the Camden Coalition of Healthcare Providers. The other authors have no conflicts of interest to disclose. Funding: Research reported in this publication was supported by a Cooperative Agreement from the NHLBI of the National Institutes of Health (NIH) under award number U01HL143475 (Bonafide, PI). As a Cooperative Agreement, NIH scientists participated in study conference calls and provided ongoing feedback on the conduct and findings of the study. Dr Schondelmeyer's effort contributing to this manuscript was in part funded by the AHRQ under award number K08HS026763. Dr Brady's effort contributing to this manuscript was in part funded by the AHRQ under award number K08HS23827. The funding organizations had no role in the design of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH or AHRQ.

ASJC Scopus subject areas

  • Fundamentals and skills
  • Care Planning
  • Assessment and Diagnosis
  • Health Policy
  • Leadership and Management
  • Internal Medicine

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