Introduction: Individual behavioral and unit cultural changes are challenging to elicit but crucial for successful quality improvement (QI) in the pediatric intensive care unit (PICU). We implemented a fellow-led, respiratory therapist (RT)-driven QI initiative to wean high flow nasal cannula (HFNC) in PICU bronchiolitis, incorporating strategies to impact staff attitudes and behaviors. We sought to characterize staff perspectives throughout this process to guide our initiative. Methods: On September 1, 2024, we launched an RT-driven decision support tool for children < 2 years of age with bronchiolitis in the PICU of a single academic children’s hospital. Efforts to promote unit-wide engagement included stakeholder involvement in project design, multidisciplinary unit champions, unit-wide educational sessions and signage, frequent solicitation of feedback, audits of adherence, and a mid-intervention educational reinforcement. Electronic surveys were distributed to PICU staff before (8/2024), during (2/2025), and after (8/2025) the QI initiative. Results: Results from the pre- (n=122) and mid-implementation (n=69) surveys were analyzed, with post-implementation results pending. Respondents included RTs (pre n=12 9.8%, mid n=20 29.9%), nurses (pre n=69 56.5%, mid n=24 34.7%), and providers, both physicians and NPs (pre n=41 33.6%, mid n=23 33.3%). Comparison shows a significant increase in perceived use of evidence-based practice (22.1% to 80.6%, p< 0.01), decrease in perceived variability in management (95.1% to 74.6%, p< 0.01), and increase in appropriateness of speed of HFNC weaning (25.4% to 44.8%, p< 0.01). However, results varied by respondent role, with 91% of PICU providers considering the new speed of weaning “just right” while 45% of nurses and 55% of RTs considered it “too fast.” Free text responses highlighted these varying perspectives as well as protocol misunderstandings. Conclusions: Staff perspectives evolved in domains of evidence-based practice and ideal HFNC weaning speed during implementation of our QI intervention. However, differences in perspective persist between staff roles. To address remaining concerns and ensure sustainability of unit culture change, continued efforts are needed to foster stronger multidisciplinary team alignment.
Kemper et al. (Sun,) studied this question.