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

TitleEHR-Integrated Monitor Data to Measure Pulse Oximetry Use in Bronchiolitis.
Publication TypeJournal Article
Year of Publication2021
AuthorsKern-Goldberger AS, Rasooly IR, Luo B, Craig S, Ferro DF, Ruppel H, Parthasarathy P, Sergay N, Solomon CM, Lucey KE, Muthu N, Bonafide CP
Corporate AuthorsPediatric Research in Inpatient Settings(PRIS) Network
JournalHosp Pediatr
Date Published2021 Sep 28
ISSN2154-1671
Abstract

BACKGROUND AND OBJECTIVES: Continuous pulse oximetry (oxygen saturation [Spo]) 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 Spo 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 Spo monitor data streamed into the EHR each minute when monitoring was active compared with in-person observation of Spo 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 Spo monitoring that occurred in the absence of supplemental oxygen.

RESULTS: Among 668 infants at 3 hospitals (validation phase), EHR-integrated Spo 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 Spo 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 Spo monitoring use that may help hospitals more efficiently identify opportunities to deimplement guideline-inconsistent use.

DOI10.1542/hpeds.2021-005894
Alternate JournalHosp Pediatr
PubMed ID34583959