Eliminating Monitor Overuse Trial (EMO Trial)

Population a: Bronchiolitis patients directly observed while not receiving supplemental oxygen ("in room air," for primary trial outcome)

Inclusion Criteria:

• Infants and children 2 months through 23 months old

• Hospitalized on non-ICU wards participating in the trial

• Cared for by generalist inpatient services (e.g. general pediatrics, hospitalmedicine)

• Primary diagnosis of bronchiolitis in most recent physician progress note

• Not actively receiving supplemental oxygen ("in room air")

• Last documented receipt of supplemental oxygen >1 hour prior to direct observationaldata collection

Exclusion Criteria:

• Documented apnea or cyanosis during the current illness

• Extreme prematurity (<28 weeks completed gestation)

• Cardiac disease

• Pulmonary hypertension

• Chronic lung disease

• Home oxygen requirement

• Neuromuscular disease

• Immunodeficiency

• Cancer

• Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19 / SARS-CoV-2)-relatedillness (known or suspected, including multisystem inflammatory syndrome in childrenmulti-system inflammatory syndrome in children (MIS-C)

Population b: Bronchiolitis patients directly observed while receiving supplemental oxygen (for underuse evaluation).

Inclusion Criteria:

• Infants and children 2 months through 23 months old

• Hospitalized on non-ICU wards participating in the trial

• Cared for by generalist inpatient services (e.g. general pediatrics, hospitalmedicine)

• Primary diagnosis of bronchiolitis in most recent physician progress note

• Actively receiving ≥2 Liters/minute (2L/min) supplemental oxygen or 21% room airflow

Exclusion Criteria:

• Extreme prematurity (<28 weeks completed gestation)

• Cardiac disease

• Pulmonary hypertension

• Chronic lung disease

• Home oxygen requirement

• Neuromuscular disease

• Immunodeficiency

• Cancer

• Severe Acute Respiratory Syndrome Coronavirus 2 [Covid-19 / SARS-CoV-2 (known orsuspected)]