title: Decreasing hospital length of stay for bronchiolitis by using an observation unit and home oxygen therapy.
abstract: OBJECTIVE
  Pediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS).
  
  
  OBJECTIVE
  To test the hypothesis that using OU-HOT for bronchiolitis would decrease LOS.
  
  
  METHODS
  Retrospective cohort study at Primary Children's Medical Center, Salt Lake City, Utah.
  
  
  METHODS
  Uncomplicated bronchiolitis patients younger than 2 years admitted during the winter seasons of 2005 through 2011.
  
  
  METHODS
  Implementation of a new bronchiolitis care process encouraging use of an OU-HOT protocol.
  
  
  METHODS
  Mean hospital LOS, discharge within 24 hours, emergency department (ED) bronchiolitis admission rates and ED revisit/readmission rates, and inflation-adjusted cost.
  
  
  RESULTS
  A total of 692 patients with bronchiolitis from the 2010-2011 bronchiolitis season were compared with 725 patients from the 2009-2010 season. Implementation of an OU-HOT protocol was associated with a 22.1% decrease in mean LOS (63.3 hours vs 49.3 hours, P < .001). Although LOS decreased during all 6 winter seasons, linear regression and linear quantile regression analyses for the 2005-2011 LOS data demonstrated a significant acceleration in the LOS decrease for the 2010-2011 season after implementation of the OU-HOT protocol. Discharges within 24 hours increased from 20.0% to 38.4% (P < .001), with no difference in ED bronchiolitis admission or ED revisit/readmission rates. After implementation of the OU-HOT protocol, the total cost per admitted case decreased by 25.4% ($4800 vs $3582, P < .001).
  
  
  CONCLUSIONS
  Implementation of an OU-HOT protocol for patients with bronchiolitis safely reduces hospital LOS with significant cost savings. Although widespread implementation has the potential for dramatic cost savings nationally, further studies assessing overall health care use and cost, including the impact on families and outpatient practices, are needed.
authors.affiliation: Primary Children’s Medical Center, University ofUtah, Salt Lake City, UT 84158, USA. david.sandweiss@hsc.utah.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Sandweiss
authors.forename: Michael B
authors.initials: MB
authors.lastname: Mundorff
authors.forename: Tracy
authors.initials: T
authors.lastname: Hill
authors.forename: Doug
authors.initials: D
authors.lastname: Wolfe
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Seth
authors.initials: S
authors.lastname: Andrews
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Glasgow
mesh_terms: D001988:Bronchiolitis / Q000191:economics / Q000628:therapy*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006701:Home Nursing; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019370:Observation; D010102:Oxygen Inhalation Therapy; D058996:Quality Improvement; D012189:Retrospective Studies; D014589:Utah