SAN DIEGO – Implementation of guidelines for the use of the high-flow nasal cannula in general pediatric wards for infants admitted with bronchiolitis can lead to significant decreases in length of stay, need for ICU level of care, and overall hospitalization costs, a retrospective chart study showed.
In the nonrandomized, pre- and postintervention chart analysis, the investigators reviewed the data for 2,446 infants under the age of 2 years who were admitted to Hasbro Children’s Hospital with a diagnosis for bronchiolitis in the 24 months before and after March 2012, when the hospital initiated high-flow nasal cannula (HFNC) protocols in its general pediatric wards.
“Admissions for bronchiolitis are extremely common for children under the age of 1 [year], and the costs associated with this are obviously quite high, but although centers around the country are now using [HFNC] for bronchiolitis, there’s little data at this point regarding the use of it on the general wards,” said Dr. Jamie Fierce of Hasbro Children’s Hospital in Providence, R.I., adding that the 2014 American Academy of Pediatrics guidelines on bronchiolitis called for more research on the efficacy of HFNC (Pediatrics 2014;134:e1474-502).
In total, 533 infants were selected for inclusion in the study, and were divided into groups based on whether they were admitted and discharged before or after the March 2012 implementation of HFNC protocols. The primary outcome measured for the study was the length of hospital stay; the median length before implementation was 4 days, while after implementation, the median length of stay decreased to 3 days (P < .001). In addition, the number of patients who required an ICU level of care decreased from the mandated 100% – because every subject who received HFNC would have to be admitted to the ICU before the new protocols were in place – to 70% of subjects after the new protocols were put in place (P < .001).
The cost of hospitalization also decreased significantly; prior to HFNC use on general wards, the median cost per patient was $12,865, but that amount decreased to $8,952 after March 2012, a difference of almost $4,000. Furthermore, there was no increase in intubation rates, nor in 30-day readmission rates from before to after March 2012. The average number of days spent on HFNC dropped from 2.5 days to 2 days, and the mean maximum HFNC rate also decreased from 9 L/min to 7 L/min, Dr. Fierce reported at the annual meeting of the Pediatric Academic Societies.
“One important limitation to this study is that it’s difficult to assess bronchiolitis severity in each of our groups, so there could have been seasonal variations that may have affected our outcomes,” he said. “Our after-implementation group is larger than our before-implementation group, and it’s hard to tell if that’s due to a seasonal increase in bronchiolitis cases, or if there was just higher use of HFNC on patients once it was allowed in the general wards.”
Demographic information was collected from the hospital billing database on subjects’ age, race, sex, and secondhand smoke exposure and whether they had public or private insurance. Although there was a statistically significant difference in age between the groups – 3 months before March 2012, 5 months after – the other demographic data were largely consistent from before implementation to after.
Dr. Fierce did not report any relevant financial disclosures.