IMPORTANCE Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time. OBJECTIVE To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs. DESIGN, SETTING, AND PARTICIPANTS This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021. MAIN OUTCOMES AND MEASURES Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars.RESULTS Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%;

IMPORTANCEThere is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis.OBJECTIVE To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes.DESIGN, SETTING, AND PARTICIPANTS This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children's hospitals in Ontario, Canada.INTERVENTIONS Intermittent (every 4 hours, n = 114) or continuous (n = 115) pulse oximetry, using an oxygen saturation target of 90% or higher. MAIN OUTCOMES AND MEASURESThe primary outcome was length of hospital stay from randomization to discharge. Secondary outcomes included length of stay from inpatient unit admission to discharge and outcomes measured from randomization: medical interventions, safety (intensive care unit transfer and revisits), parent anxiety and workdays missed, and nursing satisfaction. RESULTS Among 229 infants enrolled (median [IQR] age, 4.0 [2.2-8.5] months; 136 [59.4%] male; 101 [44.1%] from community hospital sites), the median length of hospital stay from randomization to discharge was 27.6 hours (interquartile range [IQR], 18.8-49.6 hours) in the intermittent group and 25.4 hours (IQR, 18.3-47.6 hours) in the continuous group (difference of medians, 2.2 hours; 95% CI, −1.9 to 6.3 hours; P = .17). No significant differences were observed between the intermittent and continuous groups in the median length of stay from inpatient unit admission to discharge: 49.1 (IQR, 37.2-87.0) hours vs 46.0 (IQR, 32.5-73.8) hours (P = .13) or in frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs. 9 of 115 (7.8%) (P = .16) and median duration of oxygen supplementation: 20.6 (IQR, 7.6-46.1) hours vs. 21.4 (11.6-52.9) hours (P = .66). Similarly, there were no significant differences in frequencies of intensive care unit transfer: 1 of 114 (0.9%) vs 2 of 115 (2.7%) (P = .76); readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group (P > .99); parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group (P = .40); or parent workdays missed: median workdays missed, 1.5 (IQR, 0.5-3.0) vs 1.5 (IQR, 0.5-2.5) (P = .36). Mean (SD) nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays; the mean difference was 1.5 (95% CI, 0.9-2.2; P < .001). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry. Nursing...

IntroductionThe support of families in the care of children with medical complexity (CMC) requires the integration of health care providers' (HCPs') medical knowledge and family experience. Care plans largely represent HCP information, and care maps demonstrate the family experience. Understanding the intersection between a care plan and a care map is critical, as it may provide solutions to the widely recognized tension between HCP‐directed care and patient‐ and family‐centered care (PFCC).MethodThis study used qualitative methods to explore the experience and usefulness of care maps. Parents of CMC who already had a care plan, created care maps (n = 15). Subsequent interviews with parents (n = 15) and HCPs (n = 30) of CMC regarding both care maps and care plans were conducted and analyzed using thematic analysis.ResultsData analysis exploring the relationship and utility of care plans and care maps revealed six primary themes related to using care plans and care maps that were grouped into two primary categories: (a) utility of care plans and maps; and (b) intersection of care plans and care maps.DiscussionCare plans and care maps were identified as valuable complementary documents. Their integration offers context about family experience and respects the parents' experiential wisdom in a standard patient care document, thus promoting improved understanding and integration of the family experience into care decision making.