Acceptability of Deimplementing High-Flow Nasal Cannula in Pediatric Bronchiolitis

Abstract

BACKGROUND AND OBJECTIVES: High-flow nasal cannula (HFNC) in children hospitalized with bronchiolitis does not significantly improve clinical outcomes but can increase costs and intensive care unit use. Given widespread HFNC use, it is imperative to reduce use. However, there is limited information on key factors that affect deimplementation. To explore acceptability of HFNC deimplementation, perceptions of HFNC benefits, and identify barriers and facilitators to deimplementation. METHODS: We conducted a study of health care providers that included quantitative survey data supplemented by semistructured interviews. Data were analyzed using univariate tests and thematic content analysis. RESULTS: A total of 152 (39%) providers completed the survey; 9 participated in interviews. Eighty-three (55%) providers reported feeling positively about deimplementing HFNC. Reports of feeling positively increased as perceived familiarity with evidence increased (P = .04). Physicians were more likely than nurses and respiratory therapists to report feeling positively (P = .003). Hospital setting and years of clinical experience were not associated with feeling positively (P = .98 and .55, respectively). One hundred (66%) providers attributed nonevidence-based clinical benefits to HFNC. Barriers to deimplementation included discomfort with not intervening, perception that HFNC helps, and variation in risk tolerance and clinical experience. Facilitators promoting deimplementation include staff education, a culture of safely doing less, and enhanced multidisciplinary communication. CONCLUSIONS: Deimplementation of HFNC in children with bronchiolitis is acceptable among providers. Hospital leaders should educate staff, create a culture for safely doing less, and enhance multidisciplinary communication to facilitate deimplementation.

Reducing Overutilization of High-flow Nasal Cannula in Children with Bronchiolitis

“…This high baseline is likely the result of differences in institutional practice and culture surrounding HFNC utilization, as demonstrated by a prior institutional study on understanding the acceptability of HFNC deimplementation. 14 Providers described discomfort with not intervening and the perception that HFNC helps patients appear more comfortable. We hypothesized that the utilization of HFNC at our institution had become synonymous with hospitalization for bronchiolitis, resulting in a cycle of increasing utilization.…”

“…Results showed that a majority of providers found the deimplementation of HFNC acceptable. 14 We used barriers and facilitators identified from this study to aid in developing key drivers and targeted interventions. This study grouped barriers to deimplementation into themes: discomfort with not intervening, the perception that HFNC has nonevidence-based clinical benefit, and variation in risk tolerance and clinical experience.…”

High-flow nasal cannula use in pediatric patients for other indications than acute bronchiolitis—a scoping review of randomized controlled trials

“…Because of the favoring evidence in these patient groups, the use of HFNC has expanded beyond neonatal respiratory support and bronchiolitis treatment in pediatrics. Simultaneously, there is ongoing effort to reduce the overuse of HFNC in acute bronchiolitis [ 10 , 11 ]. There are no previous systematic summaries about HFNC use as primary respiratory support for other indications in the pediatric population.…”