Guidelines for ED Observation and Home Oxygen for Patients with
Bronchiolitis
1) Only patients who meet observation inclusion criteria below and do not have exclusion criteria may
be considered for ED observation for 8 hours.
Criteria for ED Observation of Patients with Bronchiolitis
Inclusion
Exclusion
Term
Ill appearance
Previously healthy
Accessory muscle usage beyond mild subcostal
≥ 12 months for observation in OBS, ≥3
Chronic disease including BPD, RAD, asthma,
months for observation in the ED
Respiratory rate ≤ 45 breaths / min
SpO2 ≥ 85% on room air
Tolerating oral intake will
NOT responsive to albuterol, if tried
cardiac, nutritional (FTT), or airway issues
Worsening respiratory status or oxygen need
O2 need ≤½ lpm
Day 3 or more of illness
Normal CXR, if done (no atelectasis or
pneumonia)
2) After 8 hours of ED observation, if a patient meets the home oxygen criteria below, he/she may be
discharged to home with oxygen and a follow-up appointment in 24 hours in the UNM Pediatric Clinic,
Pediatric Urgent care, Family Medicine Clinic or ED. If the patient no longer has an oxygen
requirement and there is no increased work of breathing without oxygen, he/she may be discharged
off oxygen with the same follow-up as above.
Criteria for Home Oxygen from the ED
ED Attending and staff comfortable with discharge
Observed for 8 hours in the ED/Observation area
Patient still meets all of the inclusion and none of the exclusion criteria above
Documented oral intake, still tolerating po well
O2 need on RA, sleeping, feeding documented and less than or equal to ½ lpm
Documentation of respiratory status, no worsening of respiratory status
Suctioning required less often than every 4 hours
Minimal, intermittent increased work of breathing/respiratory rate when placed on room air
12-24 hour follow-up arranged: For pediatric patients or Saturday f/u: form faxed to pediatric
urgent care for appointments M-Sat and family asked to go to 3rd floor ACC. For FP patients with
f/u M-F, family asked to walk in 8:30-9:30 am in the Family Medicine Clinic (where occupational
health is, across from the Dominici building). For Sunday f/u: family asked to return to the ED.
Home O2 arranged
Parent / guardian has a telephone
3) If a patient fails to meet the home oxygen criteria, the Pediatric or Family Medicine (FM) services will
be contacted for admission or transfer of care. If, after evaluation by the attending Pediatric or FM
physician, there is a disagreement about admission, the ED attending will transfer care to the
Pediatric or FM attending and the Pediatric or FM attending will arrange alternate care and follow-up
within 2 hours of his/her evaluation. If the Pediatric or FM attending is not in house, the patient will
be admitted to the appropriate service.
4) Since all eventualities and situations cannot be predicted, the ED attending and Pediatric or FM
attendings should work cooperatively in the best interest of the patient.
Last Changed: 2/9/2016 2:00:00 PM