Eliminating Monitor Overuse Trial (EMO Trial)

Launched by CHILDREN'S HOSPITAL OF PHILADELPHIA · Nov 10, 2021

Keywords

ClinConnect Summary

The Eliminating Monitor Overuse Trial (EMO Trial) is studying ways to reduce unnecessary continuous monitoring of children with bronchiolitis, a common lung infection, who are not receiving extra oxygen while in the hospital. The goal is to find better practices for monitoring these patients so that they receive appropriate care without the stress and discomfort that can come from excessive monitoring.

Eligible participants for this trial include hospital staff like nurses and doctors who care for these young patients, as well as parents or guardians of children hospitalized for bronchiolitis. To participate, staff must be fluent in English and have worked in units caring for bronchiolitis patients recently. Parents can get involved if their child was hospitalized for bronchiolitis and is not receiving supplemental oxygen. Participants will be asked to complete questionnaires or take part in interviews to share their experiences. This research aims to improve hospital practices, ultimately leading to better care for children with bronchiolitis.

Gender

ALL

Eligibility criteria

• • Population 1a: Hospital staff who complete study questionnaires.
• Inclusion Criteria:
• • Nurse or physician fluent in English and employed full-time by the hospital, affiliated practice, or affiliated university who cared for bronchiolitis patients on a unit participating in the trial during at least 5 days of the most recent bronchiolitis season
• • Hospital administrator fluent in English who oversaw the care of bronchiolitis on a local level (e.g. nurse manager) or a hospital level (e.g. Chief Quality and Safety Officer)
• Exclusion Criteria:
• • • Under the direct supervision of study or site principal investigator(s)
• • Population 1b: Hospital staff who participate in qualitative interviews
• • In Aim 2, we will conduct semi-structured interviews with physicians and nurses who provide care to bronchiolitis patients in participating units at the 5 hospitals with the highest and 3 hospitals with the lowest sustainability (8 hospitals total; up to maximum of 8 interviews/hospital). Maximum anticipated enrollment 64.
• Inclusion criteria:
• • Nurses or Physicians who cared for bronchiolitis patients on a unit participating in the trial during at least 5 days of the most recent bronchiolitis season
• • Employed full-time by the hospital, affiliated practice, or affiliated university
• • Fluent in English
• Exclusion criteria:
• • • No exclusion criteria
• • Population 2a: Bronchiolitis patients directly observed while not receiving supplemental oxygen ("in room air," for primary trial outcome)
• Inclusion Criteria:
• • Infants and children 2 months through 23 months old
• • Hospitalized on non-ICU wards participating in the trial
• • Cared for by generalist inpatient services (e.g. general pediatrics, hospital medicine)
• • Primary diagnosis of bronchiolitis in most recent physician progress note
• • Not actively receiving supplemental oxygen ("in room air")
• • Last documented receipt of supplemental oxygen \>1 hour prior to direct observational data collection
• Exclusion Criteria:
• • Documented apnea or cyanosis during the current illness
• • Extreme prematurity (\<28 weeks completed gestation)
• • Cardiac disease
• • Pulmonary hypertension
• • Chronic lung disease
• • Home oxygen requirement
• • Neuromuscular disease
• • Immunodeficiency
• • Cancer
• • Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19 / SARS-CoV-2)-related illness (known or suspected, including multisystem inflammatory syndrome in children multi-system inflammatory syndrome in children (MIS-C)
• • Population 2b: Bronchiolitis patients directly observed while receiving supplemental oxygen (for underuse evaluation).
• Inclusion Criteria:
• • Infants and children 2 months through 23 months old
• • Hospitalized on non-ICU wards participating in the trial
• • Cared for by generalist inpatient services (e.g. general pediatrics, hospital medicine)
• • Primary diagnosis of bronchiolitis in most recent physician progress note
• • Actively receiving ≥2 Liters/minute (2L/min) supplemental oxygen or 21% room air flow
• Exclusion Criteria:
• • Extreme prematurity (\<28 weeks completed gestation)
• • Cardiac disease
• • Pulmonary hypertension
• • Chronic lung disease
• • Home oxygen requirement
• • Neuromuscular disease
• • Immunodeficiency
• • Cancer
• • Severe Acute Respiratory Syndrome Coronavirus 2 \[Covid-19 / SARS-CoV-2 (known or suspected)\]
• • Population 3: Parents or guardians of bronchiolitis patients who participate in qualitative interviews.
• Inclusion Criteria:
• • Their child was hospitalized for bronchiolitis on a unit participating in the trial during the most recent bronchiolitis season
• • Their child was found to be in room air during Aim 1 data collection
• • Fluent in English
• Exclusion criteria:
• • • They are an employee of the hospital or a hospital volunteer