The High-Flow Holiday: A QI Initiative Using a High-Flow Nasal Cannula (HFNC) Weaning Guide to Optimize Safe HFNC Weaning in Children with Bronchiolitis

Document Type

Abstract

Publication Date

11-1-2025

Abstract

Objectives/Background: Acute bronchiolitis is the leading cause of hospitalization of infants in the United States. While bronchiolitis has traditionally been managed with supportive care, high flow nasal cannula (HFNC) has emerged as a more widely accepted intervention to improve work of breathing. At our institution our patients with bronchiolitis requiring HFNC are primarily managed on the medical surgical unit (med-surg). Based on literature search there is limited data regarding standardized weaning practices of HFNC and the effects on length of stay. Our goal was to reduce average time on high flow nasal cannula by 20% in 12 months in patients under the age of 2 admitted to the medical surgical unit with bronchiolitis in a medium sized free standing children's hospital in an urban setting. Methods: An interprofessional team, led by pediatric residents and including pediatric hospitalists, registered nurses, and respiratory therapists, developed a standardized weaning pathway that was introduced to clinical staff (figure 1). We conducted a data review of patients under the age of two admitted for bronchiolitis that required HFNC and admitted to the med-surg unit from September 2022 to October 2024. The data was analyzed using excel and QI macros to assess average length of HFNC before and after introduction of standardized pathway. A Key Driver Diagram was used as a framework for this observational time series QI study (figure 2). Results: 714 patients met inclusion criteria. An Xbar-S statistical process control chart was plotted based on mean HFNC hours (figure 3). During the study period the average duration of HFNC decreased by 39.8% (35.5 hours to 21.4 hours). Special cause variation was demonstrated with eight consecutive points below the mean. No rapid responses were called on patients weaned via pathway. Length of stay remained unchanged. There were no statistically significant differences in mean hours on HFNC (p = 0.89) or mean LOS (0.93) controlling for race and ethnicity and mean hours on HFNC (p = 0.20) when controlling for preferred language. Mean LOS when controlling for language was statistically significant (p = 0.0013). Conclusion: We achieved our aim. Keys to success included development of a pathway, including the introduction of the “High-Flow Holiday”, interprofessional teamwork, and near real-time review of barriers to implementation. Next steps include use of EHR-integrated pathway tracking, further examination of disparities in LOS based on preferred language, and rational subgroup analysis for high-risk groups (premature infants and infants less than 2 months of age).

Publication Title

Academic Pediatrics

Volume

25

Issue

8

First Page

102982

Last Page

102982

Comments

APPD Annual Spring Meeting held 2025-03-26 to 2025-03-27 in Atlanta, GA.

Link to Full Text

Open Access

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