title: Effect of a Hospital-wide High-Flow Nasal Cannula Protocol on Clinical Outcomes and Resource Utilization of Bronchiolitis Patients Admitted to the PICU.
abstract: OBJECTIVE
  To assess the association of the introduction of a high-flow nasal cannula (HFNC) protocol with clinical outcomes and hospital charges of infants with bronchiolitis initially admitted to the PICU.
  
  
  METHODS
  We conducted a retrospective, nonrandomized, preintervention-postintervention study of infants with bronchiolitis initially admitted to the PICU for HFNC. We compared patients admitted in the 24 months before and after protocol initiation for HFNC use on the general wards. The primary outcome assessed was length of hospital stay (LOS), and the secondary outcomes included total hospital charges, intubation, and 30-day readmission. We conducted bivariate analysis using χ² test for categorical variables and Student's t test or Wilcoxon rank sum test for continuous variables.
  
  
  RESULTS
  Two hundred and ninety patients were admitted to the PICU on HFNC; 120 patients were admitted before and 170 admitted after the introduction of HFNC use on the general wards. Comparing the 2 groups, the median LOS was significantly reduced (4 days vs 3 days; P < .001), as was the median total hospital charges ($12 257 vs $9337; P < .001). After starting HFNC use on the wards, 30% of patients initially admitted to the PICU were ultimately transferred to the wards while still on HFNC. There was no difference in intubation rate or 30-day readmission between the 2 groups.
  
  
  CONCLUSIONS
  For bronchiolitis patients initially admitted to the PICU, initiating a guideline for HFNC use on the general pediatric wards is associated with reduced total hospital LOS and total hospital charges, with no difference in intubation rates or 30-day readmission.
authors.affiliation: Department of Pediatrics, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island jriese@lifespan.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Riese
authors.affiliation: Department of Pediatrics, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island.
authors.forename: Jamie
authors.initials: J
authors.lastname: Fierce
authors.affiliation: Department of Pediatrics, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island jriese@lifespan.org.
authors.forename: Alison
authors.initials: A
authors.lastname: Riese
authors.affiliation: Department of Pediatrics, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Alverson
mesh_terms: D001988:Bronchiolitis / Q000503:physiopathology / Q000628:therapy*; D002675:Child, Preschool; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D003422:Critical Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D014939:Work of Breathing / Q000502:physiology