eliminating monitor overuse trial (emo trial)

Conditions: Bronchiolitis Acute Viral

Summary: the purpose of this study is to identify the optimal deimplementation strategies for an overused practice: continuous pulse oximetry monitoring of children hospitalized with bronchiolitis who are not receiving supplemental oxygen.


Eligibility criteria:
population 1a: hospital staff who complete study questionnaires. inclusion criteria: * nurse or physician fluent in english and employed full-time by the hospital, affiliated practice, or affiliated university who cared for bronchiolitis patients on a unit participating in the trial during at least 5 days of the most recent bronchiolitis season * hospital administrator fluent in english who oversaw the care of bronchiolitis on a local level (e.g. nurse manager) or a hospital level (e.g. chief quality and safety officer) exclusion criteria: • under the direct supervision of study or site principal investigator(s) population 1b: hospital staff who participate in qualitative interviews in aim 2, we will conduct semi-structured interviews with physicians and nurses who provide care to bronchiolitis patients in participating units at the 5 hospitals with the highest and 3 hospitals with the lowest sustainability (8 hospitals total; up to maximum of 8 interviews/hospital). maximum anticipated enrollment 64. inclusion criteria: * nurses or physicians who cared for bronchiolitis patients on a unit participating in the trial during at least 5 days of the most recent bronchiolitis season * employed full-time by the hospital, affiliated practice, or affiliated university * fluent in english exclusion criteria: • no exclusion criteria population 2a: bronchiolitis patients directly observed while not receiving supplemental oxygen ("in room air," for primary trial outcome) inclusion criteria: * infants and children 2 months through 23 months old * hospitalized on non-icu wards participating in the trial * cared for by generalist inpatient services (e.g. general pediatrics, hospital medicine) * primary diagnosis of bronchiolitis in most recent physician progress note * not actively receiving supplemental oxygen ("in room air") * last documented receipt of supplemental oxygen \>1 hour prior to direct observational data collection exclusion criteria: * documented apnea or cyanosis during the current illness * extreme prematurity (\<28 weeks completed gestation) * cardiac disease * pulmonary hypertension * chronic lung disease * home oxygen requirement * neuromuscular disease * immunodeficiency * cancer * severe acute respiratory syndrome coronavirus 2 (covid-19 / sars-cov-2)-related illness (known or suspected, including multisystem inflammatory syndrome in children multi-system inflammatory syndrome in children (mis-c) population 2b: bronchiolitis patients directly observed while receiving supplemental oxygen (for underuse evaluation). inclusion criteria: * infants and children 2 months through 23 months old * hospitalized on non-icu wards participating in the trial * cared for by generalist inpatient services (e.g. general pediatrics, hospital medicine) * primary diagnosis of bronchiolitis in most recent physician progress note * actively receiving ≥2 liters/minute (2l/min) supplemental oxygen or 21% room air flow exclusion criteria: * extreme prematurity (\<28 weeks completed gestation) * cardiac disease * pulmonary hypertension * chronic lung disease * home oxygen requirement * neuromuscular disease * immunodeficiency * cancer * severe acute respiratory syndrome coronavirus 2 \[covid-19 / sars-cov-2 (known or suspected)\] population 3: parents or guardians of bronchiolitis patients who participate in qualitative interviews. inclusion criteria: * their child was hospitalized for bronchiolitis on a unit participating in the trial during the most recent bronchiolitis season * their child was found to be in room air during aim 1 data collection * fluent in english exclusion criteria: • they are an employee of the hospital or a hospital volunteer

Keywords: pulse oximetry deimplementation cluster-randomized trial effectiveness-implementation hybrid trial implementation science