Major Finding: The overall rate of admission for bronchiolitis fell from about 40% before implementation of the home oxygen protocol to 28% afterward.
Data Source: A retrospective study of 5,065 cases of bronchiolitis seen in the ED of a tertiary-care children's hospital, 13% of whom were managed with home oxygen therapy.
Disclosures: None was reported.
VANCOUVER, B.C. — Selected children with bronchiolitis seen in the emergency department can be safely managed with home oxygen therapy and thereby avoid hospital admission, according to Dr. Sarah M. Halstead.
In a retrospective study of more than 5,000 pediatric cases of bronchiolitis with hypoxia seen in the emergency department (ED), only 6% of children sent home on oxygen had to be admitted to the hospital at a later time.
None of them had adverse outcomes or required intensive care or placement of an advanced airway, Dr. Halstead reported.
Moreover, the ED's overall rate of hospital admission for children with bronchiolitis fell by about a third from historical levels before the home oxygen protocol was used, based on results reported at the meeting.
“To improve clinical care, we hope that this data, which does support the safety of a home oxygen program for patients with bronchiolitis seen in the ED, will encourage other institutions to consider similar home oxygen protocols,” Dr. Halstead, the lead investigator, said in a poster.
“Increasing ED overcrowding and boarding of inpatients makes the development and analysis of this and other novel outpatient care strategies imperative,” she added.
The investigators used electronic medical records to assess outcomes among children aged 1-18 months seen in the ED with bronchiolitis during the 2005 through 2009 bronchiolitis seasons, a period when the ED had a home oxygen protocol in place.
Children with cardiopulmonary conditions who required oxygen at baseline were excluded.
“Prior to discharge on home oxygen, we observed patients in the ED for 8 hours,” explained Dr. Halstead, a pediatrician at the Children's Hospital in Aurora, Colo.
“If they had oxygen saturations of greater than 90% on half a liter or less of nasal cannula oxygen, they were able to maintain adequate hydration without frequent deep suctioning, they had no signs of respiratory deterioration, and both the caregiver and the attending were comfortable with discharge home, then a follow-up appointment was arranged and … home oxygen was supplied for the family,” the pediatrician said.
Study results were based on 5,065 cases of bronchiolitis seen in the ED, 13% of whom were discharged on home oxygen therapy.
Within this group, only 6% had to be admitted at a later time—a value that did not differ significantly from the 4% seen among children discharged on room air.
The leading reason for admission after a discharge on home oxygen was an increased oxygen requirement (51%), followed by increased work of breathing (46%), parental concern or compliance issues (24%), a need for intravenous fluids (8%), and difficulties with home oxygen therapy (5%).
“There were no adverse outcomes, ICU admissions, or need for advanced airways in any of these patients,” Dr. Halstead reported at the meeting.
The ED's overall hospital admission rate for bronchiolitis (which captured both children initially admitted and children admitted after initially being sent home) was 28% during the study period'substantially lower than the 39%-40% seen historically before implementation of the home oxygen protocol.
Because some children sent home on oxygen may have been admitted later to outside institutions, the admission rate found in the study may be an underestimate, Dr. Halstead said.
She attributed the success of the home oxygen protocol in large part to support from respiratory therapists and primary care providers.
“We have respiratory therapists available in the ED 24 hours a day, 7 days a week.
“They perform home oxygen teaching and arrange for oxygen to be delivered to the family,” she noted.
“We also have support from the [primary care providers] in the community who have made themselves available for follow-up within 24 hours of discharge.
“They are comfortable caring for their patients on home oxygen, including weaning them off oxygen in an outpatient setting,” Dr. Halstead commented.