• J Hosp Med · May 2021

    Nine Seasons of a Bronchiolitis Observation Unit and Home Oxygen Therapy Protocol.

    • Timothy J D Ohlsen, Alexander M Knudson, E Kent Korgenski, David R Sandweiss, Michelle G Hofmann, Tiffany S Glasgow, and Eric R Coon.
    • Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, Utah.
    • J Hosp Med. 2021 May 1; 16 (5): 261-266.

    BackgroundWe implemented an observation unit and home oxygen therapy (OU-HOT) protocol at our children's hospital during the 2010-2011 winter season to facilitate earlier discharge of children hospitalized with bronchiolitis. An earlier study demonstrated substantial reductions in inpatient length of stay and costs in the first year after implementation.ObjectiveEvaluate long-term reductions in length of stay and cost.Design, Setting, And ParticipantsInterrupted time-series analysis, adjusting for patient demographic factors and disease severity. Participants were children aged 3 to 24 months and hospitalized with bronchiolitis from 2007 to 2019.InterventionOU-HOT protocol implementation.Main Outcome And MeasuresHospital length of stay. Process measures were the percentage of patients discharged from the OU; percentage of patients discharged with HOT. Balancing measures were 7-day hospital revisit rates; annual per-population bronchiolitis admission rates. Secondary outcomes were inflation-adjusted cost per episode of care and discharges within 24 hours.ResultsA total of 7,116 patients met inclusion criteria. The OU-HOT protocol was associated with immediate decreases in mean length of stay (-30.6 hours; 95% CI, -37.1 to -24.2 hours) and mean cost per episode of care (-$4,181; 95% CI, -$4,829 to -$3,533). These findings were sustained for 9 years after implementation. Hospital revisit rates did not increase immediately (-1.1% immediate change; 95% CI, -1.8% to -0.4%), but a small increase in revisits was observed over time (change in slope 0.4% per season, 95% CI, 0.1%-0.8%).ConclusionThe OU-HOT protocol was associated with sustained reductions in length of stay and cost, representing a promising strategy to reduce the inpatient burden of bronchiolitis.

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