ArticlePilot and feasibility studies2019
Measuring overuse of continuous pulse oximetry in bronchiolitis and developing strategies for large-scale deimplementation: study protocol for a feasibility trial.
Article in Pilot and feasibility studies, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 17 citations in OpenAlex.
- Evaluation of an Educational Outreach and Audit and Feedback Program to Reduce Continuous Pulse Oximetry Use in Hospitalized Infants With Stable Bronchiolitis: A Nonrandomized Clinical Trial.JAMA network open · 2021Trial
- Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations.Pediatrics · 2020Trial
- Article
- Implementation science for the adductor canal block: A new and adaptable methodology process.World journal of orthopedics · 2021Article
- EHR-Integrated Monitor Data to Measure Pulse Oximetry Use in Bronchiolitis.Hospital pediatrics · 2021Article
- Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis.Journal of hospital medicine · 2021Article
- Association Between Bronchiolitis Patient Volume and Continuous Pulse Oximetry Monitoring in 25 Hospitals.Journal of hospital medicine · 2020Article
- Validity of Continuous Pulse Oximetry Orders for Identification of Actual Monitoring Status in Bronchiolitis.Journal of hospital medicine · 2020Article
- Cardiorespiratory and Pulse Oximetry Monitoring in Hospitalized Children: A Delphi Process.Pediatrics · 2020Review
- Article
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Authors and funding
10 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundDeimplementation, the systematic elimination of low-value practices, has emerged as an important focus within implementation science. Bronchiolitis is the leading cause of infant hospitalization. Among stable inpatients with bronchiolitis who do not require supplemental oxygen, continuous pulse oximetry monitoring is recognized as an overused, low-value practice in pediatric hospital medicine. There is strong scientific evidence and practice guideline support for limiting pulse oximetry monitoring of stable children with bronchiolitis who do not require supplemental oxygen, yet the practice remains common. This study aims to (1) characterize the extent of this overuse in hospitals located in the USA and Canada, (2) identify barriers and facilitators of successful deimplementation of continuous pulse oximetry monitoring in bronchiolitis, and (3) develop consensus strategies for large-scale deimplementation. In addition to identifying feasible strategies for deimplementation, this study will test the feasibility of data collection approaches to be employed in a large-scale deimplementation trial.
methodsThis multicenter study will be performed in approximately 38 hospitals in the Pediatric Research in Inpatient Settings Network. In Aim 1, we will determine the rate of overuse within each hospital by performing repeated cross-sectional observational sampling of continuous pulse oximetry monitoring of stable bronchiolitis patients age 8 weeks through 23 months who do not require supplemental oxygen. In Aim 2, we will use the Consolidated Framework for Implementation Research (CFIR) as a framework for semi-structured interviews with key stakeholders (physician, nurse, respiratory therapist, administrator, and parent) at the highest- and lowest-overuse hospitals to understand barriers and facilitators of continuous pulse oximetry monitoring deimplementation. In Aim 3, we will use a theory-based causal model to match the identified barriers and facilitators to potential strategies for deimplementation. Candidate strategies will be discussed with a panel of stakeholders from hospitals with high rates of overuse to assess feasibility and acceptability. A questionnaire ranking strategies based on feasibility, acceptability, and impact will be administered to a broader group of stakeholders to arrive at consensus about promising strategies for large-scale deimplementation to be tested in a subsequent trial. DISCUSSION: Effective strategies for deimplementing continuous pulse oximetry monitoring of stable patients with bronchiolitis have not been well characterized. The findings of this study will provide further understanding of factors that facilitate deimplementation in pediatric hospital settings and provide pilot and feasibility data to inform a trial of large-scale deimplementation of this overused practice.
trial registrationNot applicable. This study does not meet the World Health Organization definition of a clinical trial.
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