Researchers from Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania have received a $5.3 million grant from the National Heart, Lung, and Blood Institute (NHLBI) to conduct the Eliminating Monitor Overuse (EMO) clinical trial, seeking to discover how best to reduce the overuse of unnecessary monitoring strategies for infants who have a common lung infection called bronchiolitis, according to press release.
The goal is to reduce these commonplace practices that are currently unsupported by evidence, save patients and hospitals from the burden of unnecessary expenses, and focus on more effective methods of monitoring pediatric health.
Deimplementation studies seek to reduce practices that are overused by clinicians, especially those known to have little or no evidence of benefit.
Bronchiolitis is the leading cause of infant hospitalization, sending more than 100,000 babies to the hospital each year and resulting in about $1.7 billion in charges annually. The disease exclusively affects children under two and occurs almost exclusively during winter. Many clinical teams use continuous pulse oximetry monitoring of oxygen saturation while treating bronchiolitis. However, when overused in stable patients who no longer require extra oxygen, this practice can lead to prolonged hospital stays and increased risk of harm, as well as contribute to alarm fatigue, which means that clinical staff may miss or ignore actual critical alarms.
The EMO Trial will involve more than 40 hospitals across the United States that are part of the Pediatric Research in Inpatient Settings (PRIS) Network. The project builds upon prior work by the EMO team that established the degree of overuse of continuous pulse oximetry and preliminary tests of different deimplementation strategies.
The current EMO Trial will test competing deimplementation strategies into participating hospitals to determine the most effective methods for reducing overuse and sustaining evidence-based practice. The study will take place over the course of three winter phases, which will establish a baseline for how much overuse is happening in a particular hospital, introduce educational outreach, data audit and feedback, and electronic health record (EHR) strategies to promote deimplementation, and compare hospitals in their long-term deimplementation sustainment, respectively.
Chris Bonafide, MD, MSCE, an attending physician at CHOP, a core faculty member of the Center for Pediatric Clinical Effectiveness at CHOP, and an Associate Professor of Pediatrics at the University of Pennsylvania, has led prior studies conducted by the EMO team that have observed successful reductions in the use of pulse oximetry in the short term. However, other deimplementation studies conducted previously at CHOP have also found that deimplementation can be challenging to sustain once strategies have been withdrawn.
“Our hope is to better understand how to achieve sustainable deimplementation so that it becomes usual practice and can ultimately improve outcomes for patient safety,” Bonafide said. “This study will not only improve patient safety, but also advance the field of implementation science, which is a scientific discipline focused on understanding the best ways to employ evidence-based practices and do away with non-evidence-based practices in real world settings.”
“This will be one of the largest projects focused on deimplementation,” says Rinad Beidas, PhD, Director of the Penn Medicine Nudge Unit and the Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), Associate Professor of Psychiatry, Medical Ethics and Health Policy, and Medicine, and one of the principal investigators on this project. “Supporting people in not doing something is an area of research that has been less emphasized, and this project is specifically focused on sustainable change, which has been a challenge for the field.”