Perspectives of Health Care Personnel on the Benefits of Bronchiolitis Interventions

Author:

Marlow Julia A.1,Kalburgi Sonal2,Gupta Vedant3,Shadman Kristin4,Webb Nicole E.5,Chang Pearl W.6,Ben Wang Xiao7,Frost Patricia A.8,Flesher Susan L.9,Le Matthew K.10,Shankar Lavanya G11,Schroeder Alan R.1,

Affiliation:

1. aDivision of Pediatric Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California

2. bDivision of Hospital Medicine, Children’s National Hospital, the George Washington School of Medicine and Health Sciences, Washington, District of Columbia

3. cDivision of Pediatric Hospital Medicine, Phoenix Children’s Hospital, Phoenix, Arizona

4. dDivision of Pediatric Hospital Medicine, Department of Pediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin

5. eDivision of Hospital Medicine, Valley Children’s Healthcare, Madera, California

6. fDivision of Pediatric Hospital Medicine, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington

7. gDivision of Pediatric Hospital Medicine, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California

8. hDivision of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee

9. iDepartment of Pediatrics, Joan C. Edwards Marshall University School of Medicine, Huntington, West Virginia

10. jPediatric Hospital Medicine, Department of Pediatrics, Oklahoma Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

11. kDivision of Hospital Medicine Outreach, Ann & Robert Lurie Children’s Hospital of Chicago, Chicago, Illinois

Abstract

OBJECTIVES Many interventions in bronchiolitis are low-value or poorly studied. Inpatient bronchiolitis management is multidisciplinary, with varying degrees of registered nurse (RN) and respiratory therapist (RT) autonomy. Understanding the perceived benefit of interventions for frontline health care personnel may facilitate deimplementation efforts. Our objective was to examine perceptions surrounding the benefit of common inpatient bronchiolitis interventions. METHODS We conducted a cross-sectional survey of inpatient pediatric RNs, RTs, and physicians/licensed practitioners (P/LPs) (eg, advanced-practice practitioners) from May to December of 2021 at 9 university-affiliated and 2 community hospitals. A clinical vignette preceded a series of inpatient bronchiolitis management questions. RESULTS A total of 331 surveys were analyzed with a completion rate of 71.9%: 76.5% for RNs, 57.4% for RTs, and 71.2% for P/LPs. Approximately 54% of RNs and 45% of RTs compared with 2% of P/LPs believe albuterol would be “extremely or somewhat likely” to improve work of breathing (P < .001). Similarly, 52% of RNs, 32% of RTs, and 23% of P/LPs thought initiating or escalating oxygen in the absence of hypoxemia was likely to improve work of breathing (P < .001). Similar differences in perceived benefit were observed for steroids, nebulized hypertonic saline, and deep suctioning, but not superficial nasal suctioning. Hospital type (community versus university-affiliated) did not impact the magnitude of these differences. CONCLUSIONS Variation exists in the perceived benefit of several low-value or poorly studied bronchiolitis interventions among health care personnel, with RNs/RTs generally perceiving higher benefit. Deimplementation, educational, and quality improvement efforts should be designed with an interprofessional framework.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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