Impact of Pulse Oximetry Surveillance on Rescue Events and Intensive Care Unit Transfers

Abstract

Background: Some preventable deaths in hospitalized patients are due to unrecognized deterioration. There are no publications of studies that have instituted routine patient monitoring postoperatively and analyzed impact on patient outcomes. Methods: The authors implemented a patient surveillance system based on pulse oximetry with nursing notification of violation of alarm limits via wireless pager. Data were collected for 11 months before and 10 months after implementation of the system. Concurrently, matching outcome data were collected on two other postoperative units. The primary outcomes were rescue events and transfers to the intensive care unit compared before and after monitoring change. Results: Rescue events decreased from 3.4 (1.89 -4.85) to 1.2 (0.53-1.88) per 1,000 patient discharges and intensive care unit transfers from 5.6 (3.7-7.4) to 2.9 (1.4 -4.3) per 1,000 patient days, whereas the comparison units had no change. Conclusions: Patient surveillance monitoring results in a reduced need for rescues and intensive care unit transfers.

Improving alarm management efficacy through predictive modeling and trending

“…Strictly examining the alarms within the scope of the study, the alarm frequency distribution resembles that of Stepdown units, with high respiratory rate, high heart rate, and low SpO 2 being the most common alarms. These alarm frequency distributions confirm existing studies that identify parameter alarms for heart rate and SpO 2 as being prone to nuisance alarms, along with the couplet arrhythmia alarm [7,11]. However, respiratory rate alarms have not been specifically identified in previously published literature, and, based on their prevalence in both the Stepdown unit and ICU distributions, merit further investigation as to their default settings.…”

“…A study from Taenzer et al discussed the connection of alarm fatigue to the total number of rescue events [7]. These do not necessarily result to patient loss, but do account for increased care costs due to patients being transferred to higher acuity levels, increased length of stay, or other complications associated with the patient's deteriorated condition.…”

“…This shows that adjustments to the alarm limit can result in large reductions in the total number of low SpO 2 alarms. Dartmouth Hitchcock Medical Center (Lexington, NH) has made the largest change to date, moving their low SpO 2 limit to 80% [7], though this has been met with some skepticism and concern, especially if this were to be implemented at higher acuity Hospital-wide "RSP HI" Alarm Condition Distribution (n = 1,980,993) levels. The more conservative limit change proposed by Graham et al, shifting the limit to 88%, has been met with greater acceptance.…”

“…Other studies focused on parameter alarms for commonly monitored vital signs, such as heart rate, peripheral oxygen saturation (SpO 2 ), and non-invasive blood pressure, along with arrhythmia alarms of similar priority level [7,11]. These alarms were included in the scope of the study, along with respiratory rate, which, in initial observations of alarm histories, appeared frequently enough to merit inclusion.…”

Prevalence of Undetected Sleep Apnea in Patients Undergoing Cardiovascular Surgery and Impact on Postoperative Outcomes

“…9,11,12 Continuous monitoring using pulse oximetry with nurse notification of violation limits via wireless pager in postoperative patients found a reduction in ICU transfers of 25% to 50% and rapid response team activations of 45% to 60% on surgical floors, resulting in a reduction of ICU days by 135 in a 1-year period. 13 Additionally, a recent study showed that reintubation in patients with OSA occurred earlier in the postoperative course and had a better prognosis than in patients without OSA. 9 This suggests that many occurrences of respiratory failure in OSA patients may be related to transient respiratory compromise which can be managed successfully with early detection.…”