600 - Reducing unnecessary oxygen use in the community setting

Publication Number: 2585.600

Jordan Silberg, Yale-New Haven Children's Hospital, Stamford, CT, United States; Patricia Basciano, Yale-New Haven Children's Hospital, Greenwich, CT, United States; Matthew Grossman, Yale School of Medicine, New Haven, CT, United States

Background: Hypoxemia is a common reason for admission for pediatric patients. There are no established national guidelines on how to wean off oxygen and there was no standardized weaning protocol at our institution. There is also limited data on how long patients require oxygen during hospitalization. After speaking with nurses and physicians, there was a sense of opportunity at our community hospital pediatric floor to reduce unnecessary oxygen use during hospitalization in a safe and timely manner.

Objective: This quality improvement initiative sought to reduce the average total hours of supplemental oxygen on the pediatric floor by 50% from a baseline of 21.8 hours in 12 months.

Design/Methods: We included all patients admitted to the floor on low flow nasal cannula or simple face mask. We excluded all patients that did not require supplemental oxygen, were on positive pressure (including high flow nasal cannula (HFNC), or on continuous albuterol. We formed a multidisciplinary QI team and using The Model for Improvement methodology, we developed a key driver diagram (Fig 1) after conducting a Failure Mode Effects Analysis and Four Corners analysis. Plan-do-study-act cycles included: developing an oxygen weaning protocol (Fig 2), sharing that protocol with providers and nurses, updating the system-wide nasal cannula order, monthly updates to providers and nurses about performance. Balancing measures included re-initiation of oxygen after weaning to room air, escalation to HFNC, and 7-day readmission.

Results: Baseline data was collected from August 2023 through July 2024 on 99 patients, and the average total hours of supplemental oxygen was 21.8 hours per patient. Each data point included the average of 5 patients. The intervention period started in August 2024, to date 80 patients were included. Special cause variation occurred in November 2024 (7 consecutive data points below the center line, Fig 3) to a new average of 14.9 hours per patient. 10 patients (12.5%) of patients went back on oxygen within 1 hour from weaning to room air. 4 patients (5%) of patients required escalation to HNFC. Zero patients required readmission within 7 days.

Conclusion(s): This project characterized the average hours of total supplemental oxygen for patients admitted to a community hospital pediatric floor. We showed significant improvement in that metric quickly through standardization of oxygen weaning protocols and orders and that improvement has been sustained. Our next step is to study oxygen utilization on a pediatric floor at the tertiary academic center in our system.

Fig 1. Key Driver Diagram


Fig 2. Pediatric Oxygen Protocol
This protocol was shared with providers, nurses, and updated into the system-wide nasal cannula order.

Fig 3. X-bar chart.
Each subgroup on x-axis represents average of 5 patients. The intervention period started after point 20. Significant shift noted between subgroups 21-27.