Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations

Schroeder, Alan R.; Marmor, Andrea; Pantell, Robert H.; Newman, Thomas B.

doi:10.1001/archpedi.158.6.527

Cited by 132 publications

(120 citation statements)

References 15 publications

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“…1 Continuous pulse oximetry (CPOx) monitoring of children hospitalized with acute respiratory disease may provide important data for titrating supplemental oxygen, but once the child's status has improved, CPOx adds little value and may prolong hospital stays. 2 Existing evidence suggests pulse oximetry readings may contribute to higher admission rates 1 and an increase in average length of stay (LOS) in bronchiolitis. 2 In its bronchiolitis guidelines, the American Academy of Pediatrics emphasized the uncertain role for CPOx in the inpatient setting, citing risk of prolonged hospital stay resulting from "perceived need for supplemental oxygen."…”

Section: Discussionmentioning

confidence: 99%

“…2 Existing evidence suggests pulse oximetry readings may contribute to higher admission rates 1 and an increase in average length of stay (LOS) in bronchiolitis. 2 In its bronchiolitis guidelines, the American Academy of Pediatrics emphasized the uncertain role for CPOx in the inpatient setting, citing risk of prolonged hospital stay resulting from "perceived need for supplemental oxygen." 3 Studies in adults have also highlighted the contribution of CPOx to alarm counts on units, [4][5][6][7][8] which the Joint Commission has emphasized as a patient safety issue.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous studies, we hypothesized that reducing CPOx overuse would result in decreased LOS on our hospital medicine units. 2 Additionally, we tracked floor-to-ICU transfers, medical emergency team (MET) activations, and hospital revisits as balancing measures to ensure that our interventions were not causing harm. Before interventions, we assembled a multidisciplinary team that included bedside nurses, resident physicians, and HM attending physicians.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Schondelmeyer¹,

Simmons²,

Statile³

et al. 2015

Pediatrics

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Schondelmeyer¹,

Simmons²,

Statile³

et al. 2015

Pediatrics

View full text Add to dashboard Cite

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“…[1][2][3][4] Hypoxia complicates 70% to 84% of bronchiolitis admissions, prolonging hospital stay by 1.6 days and representing the leading barrier to discharge. [5][6][7] Small changes in oxygen level have a significant impact on decisions to admit, suggesting that pulse oximetry could drive increased admissions in the face of stable mortality rates. [8][9][10] Pediatric hospitals located at high altitudes see a high proportion of hypoxic children with bronchiolitis.…”

mentioning

confidence: 99%

Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

et al. 2014

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BACKGROUND: Home oxygen has been incorporated into the emergency department management of bronchiolitis in high-altitude settings. However, the outpatient course on oxygen therapy and factors associated with subsequent admission have not been fully defined. METHODS: We conducted a retrospective cohort study in consecutive patients discharged on home oxygen from the pediatric emergency department at Denver Health Medical Center from 2003 to 2009. The integration of inpatient and outpatient care at our study institution allowed comprehensive assessment of follow-up rates, outpatient visits, time on oxygen, and subsequent admission. Admitted and nonadmitted patients were compared by using a χ2 test and multivariable logistic regression. RESULTS: We identified 234 unique visits with adequate follow-up for inclusion. The median age was 10 months (interquartile range [IQR]: 7–14 months). Eighty-three percent of patients were followed up within 24 hours and 94% within 48 hours. The median length of oxygen use was 6 days (IQR: 4–9 days), and the median number of associated encounters was 3 (range: 0–9; IQR: 2–3). Ninety-three percent of patients were on room air at 14 days. Twenty-two patients (9.4%) required subsequent admission. Fever at the initial visit (>38.0°C) was associated with admission (P < .02) but had a positive predictive value of 15.4%. Age, prematurity, respiratory rate, oxygen saturation, and history of previous bronchiolitis or wheeze were not associated with admission. CONCLUSIONS: There is a significant outpatient burden associated with home oxygen use. Although fever was associated with admission, we were unable to identify predictors that could modify current protocols.

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“…13,100 Oxygen saturation changes as small as 2% significantly increase a physician' s decision for admission, and the diagnosis of hypoxemia by continuous pulse oximetry prolongs hospitalization, but there is no evidence that supplemental oxygen for transient desaturations benefits children. [101][102][103] Medium-chain acyl-coenzyme A dehydrogenase deficiency A portion of newborns identified by newborn screening may never experience symptoms of their enzymatic defect. Studies have identified affected but completely asymptomatic older siblings of screening-identified newborns, 11 and some mutations identified by newborn screening have acylcarnitine profiles that normalize over time.…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

et al. 2014

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Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.

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Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations

Cited by 132 publications

References 15 publications

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

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