Ehr-integrated monitor data to measure pulse oximetry use in bronchiolitis

Abstract

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.