Using quality improvement to reduce continuous pulse oximetry use in children with wheezing

Abstract

Background and objectives: Clinicians commonly use continuous pulse oximetry (CPOx) for hospitalized children with respiratory illnesses. The Choosing Wisely initiative recommended discontinuing CPOx for children on room air. We used quality improvement methods to reduce time on CPOx in patients with wheezing.

Methods: Our project took place on 1 unit of a children's hospital. We developed consensus-based criteria for CPOx discontinuation. Interventions included education, a checklist used during nurse handoff, and discontinuation criteria incorporated into order sets. We collected data on a second unit where we did not actively intervene to assess for secular trends and negative consequences of shorter monitoring. We followed time until medically ready, ICU transfers, hospital revisits, and medical emergency team calls on both units. We tracked the impact of interventions by using run charts and statistical process control charts.

Results: Median time per week on CPOx after meeting goals decreased from 10.7 hours to 3.1 hours on the intervention unit. Median time per week on CPOx on the control unit decreased from 11.5 hours to 6.9 hours. There was no decrease in time until medically ready on either unit. The percentage of patients needing transfer, revisit, or medical emergency team call was similar on both units.

Conclusions: With interventions focused on clarity and awareness of CPOx discontinuation criteria, we decreased time on CPOx; however, we saw no impact on time until medically ready. We expect that other centers could use analogous methods to standardize and reduce oxygen monitoring to meet Choosing Wisely recommendations.

Keywords: asthma; bronchiolitis; health resources; hospital medicine.

FIGURE 1

Nursing handoff tool used for nurse-to-nurse handoff at shift change.

FIGURE 2

Run charts for intervention and control units for (A) primary outcome measure, (B) secondary outcome measure, and (C) statistical process control p-chart for process measure. Brackets indicate shared baseline data from 2012. Vertical dashed lines indicate end of baseline period. *After on >90% oxygen saturation room air or weaned to every-2-hour albuterol treatments.