Association between clinician team structure and continuous pulse oximetry overuse among infants hospitalized with bronchiolitis: An Eliminating Monitor Overuse Trial substudy.
Andrew S Kern-Goldberger, Jennifer A Faerber, Rui Xiao et al.
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In 30 seconds
This secondary analysis of the multicenter Eliminating Monitor Overuse randomized trial examined whether frontline clinician type was associated with continuous pulse oximetry (cSpO₂) overuse among hospitalized children with bronchiolitis who did not require supplemental oxygen. Across 4167 inpatient observations at 36 hospitals, adjusted odds of overuse were higher when attendings provided frontline care than when residents did (adjusted odds ratio 1.47 [95% CI 1.12–1.93], p = .01). No difference was observed between APPs and residents. The findings suggest clinician team structure may be associated with monitoring overuse.
Key findings
- Attending-led frontline care was associated with higher adjusted odds of cSpO₂ overuse than resident-led care (adjusted odds ratio 1.47 [95% CI 1.12–1.93], p = .01).
- No difference in cSpO₂ overuse was observed between APP-led and resident-led frontline care.
- The analysis included 4167 inpatient observations from 36 hospitals; 61% involved resident-led frontline care, 27% attending-led care, and 10% APP-led care.
Why it matters
Continuous oximetry in children with bronchiolitis who do not need supplemental oxygen is identified as medical overuse. The association with frontline clinician type suggests that team structure may be relevant to efforts to reduce unnecessary monitoring, while the observational comparison does not establish that clinician type causes the difference.
What to keep in mind
This was a secondary analysis comparing clinician groups rather than a randomized comparison of frontline clinician type; the findings establish an association, not causation.