title: Barriers to discharge from a 24-hour observation unit for children with bronchiolitis.
abstract: OBJECTIVE
  The aim of this study was to determine physician-identified barriers to discharge of patients with bronchiolitis from a 24-hour emergency department-based observation unit.
  
  
  METHODS
  Patients 3 to 24 months of age with a diagnosis of bronchiolitis were prospectively enrolled from January through April 2008. Patients were treated according to a standard hospital-wide bronchiolitis pathway that included an option for discharge on home oxygen. Treating physicians recorded barriers to discharge in those not sent home within 24 hours. The primary outcome was successful discharge within 24 hours; we analyzed barriers to such discharges.
  
  
  RESULTS
  Fifty-five patients were enrolled in the study. Discharge within 24 hours failed in 30 patients (55%; 95% confidence interval [CI], 42%-67%). Among the 25 discharged patients, 6 (24%) went home on supplemental oxygen without adverse outcomes or readmission. Hypoxia was the most commonly identified barrier to discharge (n = 22, 73%). Of the 22 cases where hypoxia was a barrier, 18 (82%) also noted the need for deep nasal suctioning; 12 (55%), parental discomfort; 12 (55%), respiratory distress; 10 (46%), poor feeding; and 4 (18%), MD discomfort.
  
  
  CONCLUSIONS
  Hypoxia was the most common barrier to discharge within 24 hours for patients with bronchiolitis, and a common cofactor when other barriers were identified. Research on home oxygen, the use of deep nasal suctioning, and parental discomfort with early discharge may be useful in reducing the need for inpatient care for bronchiolitis.
authors.affiliation: Primary Children's Medical Center, Salt Lake City, UT 84113, USA. david.sandweiss@hsc.utah.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Sandweiss
authors.forename: Howard M
authors.initials: HM
authors.lastname: Corneli
authors.forename: Howard A
authors.initials: HA
authors.lastname: Kadish
mesh_terms: D001988:Bronchiolitis / Q000150:complications; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D001068:Feeding and Eating Disorders / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007223:Infant; D007902:Length of Stay; D008297:Male; D009296:Nasal Cavity; D010102:Oxygen Inhalation Therapy; D010146:Pain / Q000209:etiology; D010290:Parents / Q000523:psychology; D010351:Patient Discharge; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology; D013396:Suction; D014554:Urination