A Case Study: Reducing Routine Oxygen Tests
Cincinnati Children’s Hospital Medical Center (CCHMC) is a nonprofit academic medical center that offers comprehensive clinical services, from treatments for rare and complex conditions to well-child care. CCHMC has more than 600 registered beds and approximately 1.3 million patient encounters per year.
Problem
Spurred by the prevalence of bronchiolitis and asthma among young patients at CCHMC, then-fellow Amanda Schondelmeyer, MD, MSc, began a quality improvement overuse reduction group within CCHMC’s Department of Pediatrics based on the Choosing Wisely campaign and the Society of Hospital Medicine’s recommendation against using continuous pulse oximetry (CPOx) routinely in children with acute respiratory illness who are not on supplemental oxygen. She was also motivated by the excitement of the nursing staff, who had expressed frustrations about how monitors were being used.
Solution
Under the project, the group collected vital signs and continuous pulse oximetry data over one month from electronic health records and nursing documentation. Efforts to reduce overuse began with educating both nurses and medical residents about the potential harms of pulse oximetry, including over-testing and unnecessary extensions of hospital stays. Interventions included developing criteria on when to discontinue monitoring and incorporating this criteria into CCHMC’s electronic health record order set and a checklist used in nursing handoffs.
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