124 - Decreasing Goal Oxygen Saturations in Children Hospitalized with Bronchiolitis is Associated with Decreased Length of Stay

Poster Number: 124
Publication Number: 124.415

Shivani R. Desai, Phoenix Children's Hospital, Phoenix, AZ, United States; Vedant Gupta, Phoenix Children's Hospital, Phoenix, AZ, United States; Nehal Thakkar, Phoenix Children's Hospital, Phoenix, AZ, United States; Jamie Librizzi, Phoenix Children's Hospital, Phoenix, AZ, United States; Hamy Temkit, Phoenix Children's Hospital, Phoenix, AZ, United States; Richard Engel, Phoenix Children's Hospital, Scottsdale, AZ, United States

Background: Many hospitals have implemented clinical practice guidelines to standardize care for bronchiolitis. Our tertiary care hospital recently updated its inpatient bronchiolitis clinical pathway, which included decreasing the goal oxygen saturation for supplemental oxygen from 90% to 88%.

Objective: To evaluate the impact of lowering the goal oxygen saturation from 90% to 88% on clinical outcomes for patients hospitalized with bronchiolitis.

Design/Methods: A retrospective chart review of patients 0-24 months old admitted to a pediatric tertiary care center from 2019 –2021 with a diagnosis of bronchiolitis. The pre-update data included those with bronchiolitis ICD-10 codes, while the post-update data included those with the updated bronchiolitis clinical pathway ordered. Patients with congenital heart disease, asthma, on home oxygen, or who were initially admitted to the intensive care unit (ICU) were excluded. Demographics, admission rate, time to room air, length of stay (LOS) and readmission rate were extracted from the electronic medical record. The data was stratified between patients admitted before (11/1/19 to 11/17/20) and after (11/18/20 to 9/30/21) the clinical pathway update. Descriptive statistics were used for each group. Group comparisons were conducted using the chi-squared test for categorical variables and the Wilcoxon rank-sum test for continuous variables.

Results: A total of 1083 unique patients were included, 779 pre-update and 304 post-update. There was a significant difference in mean age between the two groups (7.32 versus 9.13 months, p-value < 0.01) (Table 1). There was no statistically significant difference in the admission rate between the two groups (p-value 0.26). The mean time to room air was 55.92 hours in the pre-update group versus 46.53 hours in the post-update group (p-value 0.01). The mean LOS for patients admitted pre-update was 63.49 hours versus 56.8 hours (p-value 0.02) for those in the post-update group. While the 7-day readmission rate pre-update was only 0.6%, there were no 7-day readmissions in the post-update group (p-value 0.16) (Table 2).Conclusion(s): Decreasing the goal oxygen saturation to 88% was associated with a statistically significant decrease in time spent on oxygen and length of stay for patients admitted with bronchiolitis with no increase in readmissions. Our study suggests lowering goal oxygen saturations is a safe intervention to improve clinical outcomes for patients hospitalized with bronchiolitis.
Table 1Patient Demographics
Table 2Clinical Data