EHR-Integrated Monitor Data to Measure Pulse Oximetry Use in Bronchiolitis

Hosp Pediatr. 2021 Oct;11(10):1073-1082. doi: 10.1542/hpeds.2021-005894.


Background and objectives: Continuous pulse oximetry (oxygen saturation [Spo2]) monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen is discouraged by national guidelines, but determining monitoring status accurately requires in-person observation. Our objective was to determine if electronic health record (EHR) data can accurately estimate the extent of actual Spo2 monitoring use in bronchiolitis.

Methods: This repeated cross-sectional study included infants aged 8 weeks through 23 months hospitalized with bronchiolitis. In the validation phase at 3 children's hospitals, we calculated the test characteristics of the Spo2 monitor data streamed into the EHR each minute when monitoring was active compared with in-person observation of Spo2 monitoring use. In the application phase at 1 children's hospital, we identified periods when supplemental oxygen was administered using EHR flowsheet documentation and calculated the duration of Spo2 monitoring that occurred in the absence of supplemental oxygen.

Results: Among 668 infants at 3 hospitals (validation phase), EHR-integrated Spo2 data from the same minute as in-person observation had a sensitivity of 90%, specificity of 98%, positive predictive value of 88%, and negative predictive value of 98% for actual Spo2 monitoring use. Using EHR-integrated data in a sample of 317 infants at 1 hospital (application phase), infants were monitored in the absence of oxygen supplementation for a median 4.1 hours (interquartile range 1.4-9.4 hours). Those who received supplemental oxygen experienced a median 5.6 hours (interquartile range 3.0-10.6 hours) of monitoring after oxygen was stopped.

Conclusions: EHR-integrated monitor data are a valid measure of actual Spo2 monitoring use that may help hospitals more efficiently identify opportunities to deimplement guideline-inconsistent use.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bronchiolitis* / diagnosis
  • Bronchiolitis* / therapy
  • Child
  • Cross-Sectional Studies
  • Electronic Health Records*
  • Humans
  • Infant
  • Monitoring, Physiologic
  • Oximetry
  • Oxygen


  • Oxygen