TY - JOUR
T1 - Ehr-integrated monitor data to measure pulse oximetry use in bronchiolitis
AU - Kern-Goldberger, Andrew S.
AU - Rasooly, Irit R.
AU - Luo, Brooke
AU - Craig, Sansanee
AU - Ferro, Daria F.
AU - Ruppel, Halley
AU - Parthasarathy, Padmavathy
AU - Sergay, Nathaniel
AU - Solomon, Courtney M.
AU - Lucey, Kate E.
AU - Muthu, Naveen
AU - Bonafide, Christopher P.
N1 - Publisher Copyright:
© 2021 by the American Academy of Pediatrics.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - BACKGROUND AND OBJECTIVES: Continuous pulse oximetry (oxygen saturation [SpO2]) 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 SpO2 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 SpO2 monitor data streamed into the EHR each minute when monitoring was active compared with in-person observation of SpO2 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 SpO2 monitoring that occurred in the absence of supplemental oxygen. RESULTS: Among 668 infants at 3 hospitals (validation phase), EHR-integrated SpO2 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 SpO2 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 validmeasure of actual SpO2monitoring use that may help hospitalsmore efficiently identify opportunities to deimplement guideline-inconsistent use.
AB - BACKGROUND AND OBJECTIVES: Continuous pulse oximetry (oxygen saturation [SpO2]) 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 SpO2 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 SpO2 monitor data streamed into the EHR each minute when monitoring was active compared with in-person observation of SpO2 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 SpO2 monitoring that occurred in the absence of supplemental oxygen. RESULTS: Among 668 infants at 3 hospitals (validation phase), EHR-integrated SpO2 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 SpO2 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 validmeasure of actual SpO2monitoring use that may help hospitalsmore efficiently identify opportunities to deimplement guideline-inconsistent use.
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U2 - 10.1542/hpeds.2021-005894
DO - 10.1542/hpeds.2021-005894
M3 - Article
C2 - 34583959
AN - SCOPUS:85127177208
SN - 2154-1663
VL - 11
SP - 1073
EP - 1081
JO - Hospital Pediatrics
JF - Hospital Pediatrics
IS - 10
ER -