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Potential bed-day savings and caregiver perspectives of transitioning hospital-level management of infants with bronchiolitis to the home: a mixed-methods study
  1. Joanna Lawrence1,
  2. Harriet Hiscock2,3,
  3. Penelope A Bryant4,
  4. Genevieve Greig1,
  5. Anurag Sharma5,
  6. Ramesh Walpola5
  1. 1Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. 3Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
  4. 4General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
  5. 5University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Joanna Lawrence, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; joanna.lawrence{at}rch.org.au

Abstract

Objective Home management of infants admitted to hospital with bronchiolitis would alleviate pressure on hospital beds. We aim to understand the proportion of children requiring active care interventions (ie, oxygen, fluids), caregiver perspectives and potential impact of transitioning hospital-level care of infants with bronchiolitis to home.

Methods This is a mixed-methods study in an Australian tertiary paediatric hospital. Semistructured interviews with caregivers of infants with bronchiolitis focused on attitudes towards managing bronchiolitis at home. Interviews were analysed using inductive thematic analysis. Data on bronchiolitis admissions among infants aged 1–12 months were extracted from the electronic medical record from April 2016 to October 2020. Potential bed-days saved were calculated.

Results 18 parents were interviewed, with themes emerging of ‘hospital is safe’, ‘hospital incurs costs’ and ‘knowledge is power’. During 4.5 years, 2367 infants were admitted to hospital with bronchiolitis: a total of 4557 bed-days. Of these, 40% of infants were admitted for monitoring alone, 25% for nasogastric fluid support, 17% for oxygen therapy and 7.5% for both fluids and oxygen. 11% received treatments not currently feasible at home (high-flow oxygen, intravenous fluids). Oxygen therapy accounted for the largest number of bed-days (242 bed-days/year).

Conclusion Managing bronchiolitis at home could have a substantial impact on hospital bed demand, with an estimated 344 bed-days saved per year if all interventions were offered. Parent willingness to transfer to home balances the perceived safety of the hospital versus the financial, logistic and emotional costs. Empowering parents with knowledge was seen as a substantial facilitator of supporting transition to the home.

  • Health services research
  • Paediatrics

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors JL designed the interview guide, conducted interviews, analysed the data, drafted the initial manuscript, and critically reviewed and revised the manuscript. JL holds ultimate responsibility for the work presented. GG conducted interviews, analysed the data and reviewed the manuscript. HH, PAB and AS supported the study design including review of the interview guide and conduct and critically reviewed and revised the manuscript. RW provided senior mentoring on all aspects of the study and critically reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.