The Alarm Burden of Excess Continuous Pulse Oximetry Monitoring Among Patients With Bronchiolitis

Abstract

Guidelines discourage continuous pulse oximetry monitoring of hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. Excess monitoring is theorized to contribute to increased alarm burden, but this burden has not been quantified. We evaluated admissions of 201 children (aged 0-24 months) with bronchiolitis. We categorized time ≥60 minutes following discontinuation of supplemental oxygen as “continuously monitored (guideline-discordant),” “intermittently measured (guideline-concordant),” or “unable to classify.” Across 4402 classifiable hours, 77% (11,101) of alarms occurred during periods of guideline-discordant monitoring. Patients experienced a median of 35 alarms (interquartile range [IQR], 10-81) during guideline-discordant, continuously monitored time, representing a rate of 6.7 alarms per hour (IQR, 2.1-12.3). In comparison, the median hourly alarm rate during periods of guideline-concordant intermittent measurement was 0.5 alarms per hour (IQR, 0.1-0.8). Reducing guideline-discordant monitoring in bronchiolitis patients would reduce nurse alarm burden.

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

“…1 Using continuous pulse oximetry (cSpO 2 ) to monitor children with bronchiolitis who are not receiving supplemental oxygen is a form of medical overuse discouraged by three national guidelines [2][3][4] that contributes to increased healthcare utilization, unnecessary alarms, and does not improve patient outcomes. [5][6][7][8][9] The Eliminating Monitor Overuse (EMO) portfolio of projects, funded since 2018 by U01 awards from the National Heart, Lung, and Blood Institute, broadly aims to deimplement cSpO 2 overuse in Pediatric Research in Inpatient Settings (PRIS) Network hospitals. In this analysis, we aimed to assess the changes in cSpO 2 monitoring overuse (percentage of bronchiolitis patients who are cSpO 2monitored while not receiving any supplemental oxygen) before, during, and after an active cSpO 2 -deimplementation period, with a particular focus on sustainment.…”

“…Acute viral bronchiolitis is a common cause of hospitalization in infants, with more than 100,000 admissions each year 1 . Using continuous pulse oximetry (cSpO 2 ) to monitor children with bronchiolitis who are not receiving supplemental oxygen is a form of medical overuse discouraged by three national guidelines 2–4 that contributes to increased healthcare utilization, unnecessary alarms, and does not improve patient outcomes 5–9 …”

Sustainable deimplementation of continuous pulse oximetry monitoring in children hospitalized with bronchiolitis: study protocol for the Eliminating Monitor Overuse (EMO) type III effectiveness-deimplementation cluster-randomized trial

“…Rather, in those patients, continuous SpO 2 monitoring may identify brief, self-limited desaturations that do not require treatment and do not affect patient outcomes [ 15 ]. Overuse of continuous SpO 2 monitoring is associated with increased oxygen administration, prolonged length of stay, unnecessary monitor alarms that can generate alarm fatigue, and increased costs [ 16 – 18 ]. Two clinical trials have demonstrated that intermittent SpO 2 measurement is an equally safe alternative to continuous SpO 2 monitoring for children in room air [ 19 , 20 ], and three sets of national guidelines now discourage the use of continuous SpO 2 monitoring in hospitalized children with bronchiolitis who are in room air [ 11 , 21 , 22 ].…”