135 - Understanding the association between provider type and perceived efficacy of common interventions in bronchiolitis

Poster Number: 135
Publication Number: 135.415

Julia A. Marlow, Stanford University School of Medicine, Los Altos, CA, United States; Alan Schroeder, Stanford, Palo Alto, CA, United States; Matthew Le, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Nicole E. Webb, Valley Children’s Healthcare, Madera, CA, United States; Vedant Gupta, Phoenix Children's Hospital, Phoenix, AZ, United States; Susan L. Flesher, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, United States; Pearl Chang, Seattle Children's Hospital / University of Washington, Seattle, WA, United States; Kristin Shadman, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Ben Wang, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Lavanya Shankar, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Patricia Frost, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Sonal Kalburgi, Children's National Health System, Washington, DC, United States

Background:
Despite extensive study, use of non-efficacious interventions in bronchiolitis (e.g., bronchodilators and steroids) remains common, and the efficacy of supplemental oxygen is poorly characterized, making the condition a common target for de-implementation. Inpatient bronchiolitis management is multidisciplinary, with varying degrees of autonomy by nurses (RNs) and respiratory therapists (RTs). Evidence for medical decision-making remains centered around physicians; limited data exist comparing RN, RT, and LIP (licensed independent providers, i.e. physicians and advanced-practice providers) perspectives of common interventions, especially supplemental O2, which is often titrated by RNs/RTs. A better understanding of the perspectives of all frontline healthcare providers may help focus de-implementation efforts.

Objective:
To examine provider perceptions surrounding the benefit of routine interventions in bronchiolitis. We hypothesize that RNs/RTs are more likely than LIPs to perceive benefit for most interventions.

Design/Methods:
We conducted a multi-site, cross-sectional survey of acute care RNs, RTs, and LIPs from May-December of 2021. We recruited participating institutions through the PRIS Network. One of 2 clinical vignettes (Figure 1) was randomly presented followed by a series of questions pertaining to management practices and demographics. The vignettes were identical other than the infant was on room air (RA) in one and on 1 LPM O2 in the other. We used Likert scales and dichotomized most responses. We used chi-square or Fisher’s exact tests to compare proportions.

Results:
Surveys were completed by 372 respondents from 11 sites: 9 university-affiliated hospitals and 2 community hospitals. Response rates were 86.1%, 57.1%, and 78.4% for RNs, RTs, and LIPs. There were significant differences between provider types for most interventions, with RNs/RTs generally perceiving higher likelihood of benefit than LIPs (Table 1). Respondents in the 1LPM group were more likely to find benefit in increasing oxygen (46.5%) than respondents in the RA group (30.1%). Drivers of albuterol and oxygen use are depicted in Table 2.
Conclusion(s):
There is significant variation in the perceived utility of interventions in bronchiolitis among frontline providers, with RNs and RTs generally having higher perceived efficacy. Given that interventions are often ordered “PRN” and/or are titrated by non-LIPs, educational de-implementation efforts should be designed with an interprofessional framework.

Figure 1. One of 2 clinical vignettes presented to providers**The only difference between vignettes was whether the patient was on room air, as seen in this vignette, or had been started on 1 liter per minute nasal cannula oxygen in the second vignette.
**Adapted from Mallory et. al., Pediatrics 2003. PMID: 12509594
Table 1. Percent of providers who find intervention “somewhat likely” or “very likely” to improve work of breathing for an infant with bronchiolitis.