Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis Suctioning in Bronchiolitis

Mussman GM, Parker MW, Statile A, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Hospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning.

Objective

To examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis.

Design

Retrospective cohort study. Data were extracted from the electronic health record.

Setting

Main hospital and satellite facility of a large quaternary care children's hospital from January 10, 2010, through April 30, 2011.

Participants

A total of 740 infants aged 2 to 12 months and hospitalized with bronchiolitis.

Main Outcome Measure

Hospital LOS.

Results

In the multivariable model adjusted for inverse weighting for propensity to receive deep suctioning, increased deep suction as a percentage of suction events was associated with increased LOS with a geometric mean of 1.75 days (95% CI, 1.56-1.95 days) in patients with no deep suction and 2.35 days (2.10-2.62 days) in patients with more than 60% deep suction. An increased number of suctioning lapses was also associated with increased LOS in a dose-dependent manner with a geometric mean of 1.62 days (95% CI, 1.43-1.83 days) in patients with no lapses and 2.64 days (2.30-3.04 days) in patients with 3 or 4 lapses.

Conclusions and Relevance

For patients admitted with bronchiolitis, the use of deep suctioning in the first 24 hours after admission and lapses greater than 4 hours between suctioning events were associated with longer LOS.

Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy Decreasing Hospital LOS for Bronchiolitis

Sandweiss DR, Mundorff MB, Hill T, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Pediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS).

Objective

To test the hypothesis that using OU-HOT for bronchiolitis would decrease LOS.

Design and Setting

Retrospective cohort study at Primary Children's Medical Center, Salt Lake City, Utah.

Participants

Uncomplicated bronchiolitis patients younger than 2 years admitted during the winter seasons of 2005 through 2011.

Interventions

Implementation of a new bronchiolitis care process encouraging use of an OU-HOT protocol.

Main Outcome Measures

Mean hospital LOS, discharge within 24 hours, emergency department (ED) bronchiolitis admission rates and ED revisit/readmission rates, and inflation-adjusted cost.

Results

A total of 692 patients with bronchiolitis from the 2010-2011 bronchiolitis season were compared with 725 patients from the 2009-2010 season. Implementation of an OU-HOT protocol was associated with a 22.1% decrease in mean LOS (63.3 hours vs 49.3 hours, P < .001). Although LOS decreased during all 6 winter seasons, linear regression and linear quantile regression analyses for the 2005-2011 LOS data demonstrated a significant acceleration in the LOS decrease for the 2010-2011 season after implementation of the OU-HOT protocol. Discharges within 24 hours increased from 20.0% to 38.4% (P < .001), with no difference in ED bronchiolitis admission or ED revisit/readmission rates. After implementation of the OU-HOT protocol, the total cost per admitted case decreased by 25.4% ($4800 vs $3582, P < .001).

Conclusions and Relevance

Implementation of an OU-HOT protocol for patients with bronchiolitis safely reduces hospital LOS with significant cost savings. Although widespread implementation has the potential for dramatic cost savings nationally, further studies assessing overall health care use and cost, including the impact on families and outpatient practices, are needed.

AMA Publishing Group: Infectious Respiratory Diseases Topic Collection

Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis Suctioning in Bronchiolitis

Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy Decreasing Hospital LOS for Bronchiolitis