Association between clinician team structure and continuous pulse oximetry overuse among infants hospitalized with bronchiolitis: An Eliminating Monitor Overuse Trial substudy

Abstract

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.