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, Spandana Makeneni, Kimberly Albanowski, Canita R. Brent, Halley Ruppel, Tina V. Halley, Kaitlyn M. McQuistion, Enrique F. Schisterman, Rinad S. Beidas, Christopher P. Bonafide,Abstract
Continuous pulse oximetry (cSpO 2 ) monitoring for hospitalized children with bronchiolitis not requiring supplemental oxygen is an established form of medical overuse. We examined whether clinician team structure influences cSpO 2 overuse. In this secondary analysis of the Eliminating Monitor Overuse (EMO) Trial (NCT05132322), we compared overuse by frontline clinician type (resident physician vs. attending physician or advanced practice provider [APP]) during the active cSpO 2 deimplementation and sustainment phases using multivariable mixed‐effects logistic regression. Among 4167 inpatient observations in 36 hospitals, 61% had their frontline care provided by residents, 27% by attendings, and 10% by APPs. In adjusted analyses, the odds of overuse were 47% higher among patients with frontline care delivered by attendings compared with residents (adjusted odds ratio: 1.47 [95% confidence interval [CI]: 1.12–1.93], p = .01), with no difference observed for APPs compared with residents. These findings suggest that cSpO 2 overuse may be attenuated when residents deliver frontline patient care rather than attendings alone.