Enough Is Enough: Quality Improvement to Deimplement High-Flow Nasal Cannula in Bronchiolitis.

High-flow nasal cannula (HFNC): nobody seems to like it, but everyone seems to be using it as the newest treatment of bronchiolitis. Although supportive care is the mainstay of treatment,1 we as a medical community continue to seek interventions for this self-limited viral disease process, with the good intentions to minimize suffering and limit time families spend in the hospital. As hospitalists, we strive to provide efficient care and were quick to partner with our critical care colleagues to make HFNC therapy available on the acute care wards, in an attempt to avoid costly ICU stays. In the last several years, in 2 randomized controlled trials, researchers found that early initiation of HFNC reduces the need for later rescue therapy2,3 (notably, most often to HFNC), but that HFNC does little to mitigate the disease process and does not reduce the length of time oxygen therapy is needed nor the frequency of ICU transfers.4 Despite this, the use of HFNC nationally has risen.5 In this issue of Hospital Pediatrics , Charvat et al6 and Noelck et al7 share 2 quality improvement (QI) studies to implement standardized weaning protocols as a first step toward establishing appropriate HFNC therapy use. Both Charvat et al6 and Noelck et al7 used QI methodology to address the discontinuation of HFNC, one …