Study: NCT05132322

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Educational Outreach
Description: Educational outreach includes staff-targeted educational materials and outreach sessions summarizing the current evidence and guideline recommendations for pulse oximetry use in bronchiolitis.

Intervention type: BEHAVIORAL
Group type: ACTIVE_COMPARATOR
Intervention: Educational Outreach
Description: Educational outreach includes staff-targeted educational materials and outreach sessions summarizing the current evidence and guideline recommendations for pulse oximetry use in bronchiolitis.

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Audit & Feedback (unit level)
Description: Weekly unit-level feedback of each hospital's guideline-concordant practice will be distributed to sites in the form of a visual dashboard that includes comparisons over time and between hospitals. The dashboard will then be shared locally on a weekly basis with clinicians in person and electronically.

Intervention type: BEHAVIORAL
Group type: ACTIVE_COMPARATOR
Intervention: Audit & Feedback (unit level)
Description: Weekly unit-level feedback of each hospital's guideline-concordant practice will be distributed to sites in the form of a visual dashboard that includes comparisons over time and between hospitals. The dashboard will then be shared locally on a weekly basis with clinicians in person and electronically.

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Audit & Feedback (real time, individual-level)
Description: Real-time feedback will occur at the individual clinician level. When collecting data on an individual patient, data collectors encountering guideline-discordant continuous monitoring are empowered to briefly ask any available clinician responsible for that patient's care, in a nonjudgmental way, about indications for monitoring that patient. The clinician is ultimately responsible for deciding if any changes are indicated.

Intervention type: BEHAVIORAL
Group type: ACTIVE_COMPARATOR
Intervention: Audit & Feedback (real time, individual-level)
Description: Real-time feedback will occur at the individual clinician level. When collecting data on an individual patient, data collectors encountering guideline-discordant continuous monitoring are empowered to briefly ask any available clinician responsible for that patient's care, in a nonjudgmental way, about indications for monitoring that patient. The clinician is ultimately responsible for deciding if any changes are indicated.

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Clinical Pathway Integrated into Electronic Health Record
Description: Clinical pathways guide clinicians step-by-step through evidence-based care. Based on the existing guidelines for physiologic monitoring in bronchiolitis, the pathway will clearly specify (a) situations when it is appropriate to initiate intermittent SpO2 measurement instead of continuous SpO2 monitoring, and (b) when it is appropriate to discontinue continuous SpO2 monitoring altogether, and transition to intermittent SpO2 measurement. In order to be visible to clinicians as they perform patient care, the pathway will be integrated into the electronic health record at sites randomized to this intervention.