Eliminating Monitor Overuse Trial (EMO Trial)

Population 1a: Hospital staff who complete study questionnaires.

Inclusion Criteria:

• Nurse or physician fluent in English and employed full-time by the hospital,affiliated practice, or affiliated university who cared for bronchiolitis patientson a unit participating in the trial during at least 5 days of the most recentbronchiolitis season

• Hospital administrator fluent in English who oversaw the care of bronchiolitis on alocal level (e.g. nurse manager) or a hospital level (e.g. Chief Quality and SafetyOfficer)

Exclusion Criteria:

• Under the direct supervision of study or site principal investigator(s)

Population 1b: Hospital staff who participate in qualitative interviews

In Aim 2, we will conduct semi-structured interviews with physicians and nurses who provide care to bronchiolitis patients in participating units at the 5 hospitals with the highest and 3 hospitals with the lowest sustainability (8 hospitals total; up to maximum of 8 interviews/hospital). Maximum anticipated enrollment 64.

Inclusion criteria:

• Nurses or Physicians who cared for bronchiolitis patients on a unit participating inthe trial during at least 5 days of the most recent bronchiolitis season

• Employed full-time by the hospital, affiliated practice, or affiliated university

• Fluent in English

Exclusion criteria:

• No exclusion criteria

Population 2a: 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 2b: 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)]

Population 3: Parents or guardians of bronchiolitis patients who participate in qualitative interviews.

Inclusion Criteria:

• Their child was hospitalized for bronchiolitis on a unit participating in the trialduring the most recent bronchiolitis season

• Their child was found to be in room air during Aim 1 data collection

• Fluent in English

Exclusion criteria:

• They are an employee of the hospital or a hospital volunteer