P3.261: Heated High-Flow Nasal Cannula on Transport

Purpose/Objectives: This tertiary facility has a heated high-flow nasal cannula (HHFNC) protocol for patients admitted via the emergency department, which determines which populations are stable for the floor versus being admitted to the PICU (Figure 1). To expedite care to vulnerable populations and minimize the use of Intensive Care resources, the transport team at this facility has implemented a quality improvement (QI) initiative to allow for direct admission of patients on HHFNC that fit within the protocol guidelines, to the floor from outside facilities.

Design/Methods: The goal of this QI project is to reduce the number of patients admitted to the PICU from outside facilities on HHFNC and align with organizational practices of admitting patients on HHFNC to the floors. Using organizational standards and local consensus, a protocol was developed with relevant stakeholder input for use at the institution and with transport team members. Intervention implementation with educational presentations, staff meeting follow-up, and monthly stakeholder QI meetings were completed with transport team members (nurses, respiratory therapists, and physicians), in house physicians, and in house respiratory therapists since October 2024. Data were collected from electronic transport records and reviewed by a QI team of representatives. The metric measured was the percentage of patients from outside facilities that arrived on HHFNC and were admitted to the PICU with a goal to reduce the number of patients admitted to the PICU by 25 percent.

Results: Data for 2023 and 2024 showed 67 patients taken to the pediatric intensive care unit (PICU) on HHFNC. Of those patients, 44 met criteria for floor admission based on the in-house protocol. In response to this, the transport team initiated the use of respiratory scoring in transport to determine eligibility of patients for floor admission from outside facilities. In July 2024, scoring compliance was below 50%, and reeducation on scoring criteria was completed with transport team members. Implementation of the transport HHFNC protocol was initiated in October 2024.
In July 2024, respiratory scoring was initiated on all patients meeting scoring inclusion criteria. In October 2024, the team implemented the first PDSA cycle, initiating the transport HHFNC protocol. The team saw immediate results with four of 13 patients meeting protocol criteria being admitted to the floors in the first four months. In February, relevant stakeholders met to discuss the expansion of the protocol to patients not meeting protocol inclusion criteria. While the team has opted not to expand currently, the hope is for this in the future.

Conclusion/Discussion: Data collection from the post-implementation period is ongoing. By September, data analysis into the implementation period should be completed and initial impacts on measured metrics will be better appreciated.