Sustainment of continuous pulse oximetry deimplementation: Analysis of Eliminating Monitor Overuse study data from six hospitals

Abstract

Using continuous pulse oximetry (cSpO 2 ) to monitor children with bronchiolitis who are not receiving supplemental oxygen is a form of medical overuse. In this longitudinal analysis from the Eliminating Monitor Overuse (EMO) study, we aimed to assess changes in cSpO 2 overuse before, during, and after intensive cSpO 2deimplementation efforts in six hospitals. Monitoring data were collected during three phases: "P1" baseline, "P2" active deimplementation (all sites engaged in education and audit and feedback strategies), and "P3" sustainment (a new baseline measured after strategies were withdrawn). Two thousand and fifty-three observations were analyzed. We found that each hospital experienced reductions during active deimplementation (P2), with overall adjusted cSpO 2 overuse decreasing from 53%, 95% confidence interval (CI): (49-57) to 22%, 95% CI:(19-25) between P1 and P2. However, following the withdrawal of deimplementation strategies, overuse rebounded in all six sites, with overall adjusted cSpO 2 overuse increasing to 37%, 95% CI: (33-41) in P3.

Research Accomplishments in Pulmonary, Critical Care, and Sleep: A Retrospective Review

“…The investigators used innovative strategies such as telehealth-enabled, real-time audit and feedback and interprofessional education and collaboration ( 20 ). Another study from the same funding opportunity addresses the challenge of deimplementing continuous pulse oximetry in children with viral bronchiolitis who are not receiving oxygen, a practice that is not supported by evidence and may even be harmful ( 21 ). These examples of the use of implementation science approaches to ensure that current evidence-based interventions reach every patient’s bedside hold tremendous promise, despite the challenges of conducting research in acute care settings.…”