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

Article (PDF Available)inAnesthesiology 112(2):282-7 · February 2010with176 Reads
DOI: 10.1097/ALN.0b013e3181ca7a9b · Source: PubMed
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. 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. 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. Patient surveillance monitoring results in a reduced need for rescues and intensive care unit transfers.


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Available from: Andreas H Taenzer
    • "If the patient is discovered at this later stage and resuscitated, immediately drawn blood gases could show PaCO 2 to be moderately elevated, enough to disguise this Type III incident mistakenly as a Type II event. But unlike Type II events where an optimal continuous pulse oximetry ATV could be argued to be 90% SPO 2 , the preponderance of self correcting sleep apneas and associated SPO 2 desaturations that are associated with the prevalence of OSA, opioid therapy, and postoperative conditions in general, make this alarm threshold value (ATV) for the Type III Pattern of Respiratory Dysfunction both unmanageable and unsafe on GCF when monitoring all patients without exclusion [4,5,7]. "
    [Show abstract] [Hide abstract] ABSTRACT: Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.
    Full-text · Article · Jul 2014
    • "However, an evaluation of such systems has been limited. Recent studies have found that continuous surveillance with a nurse notification component reduced transfers to critical care (CC) (Taenzer et al., 2010) or improved early identification of postoperative patients requiring CC admission (Ochroch et al., 2006). However, these studies did not evaluate factors or system shortfalls that potentially impede nursing response, leaving significant gaps in our understanding of safe monitoring practices. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Continuous pulse oximetry monitoring is recommended to improve safety during postoperative opioid use, however concerns with monitoring on general care units remain, given potential system barriers to alarm transmission, recognition, and nursing response. Methods: This prospective, observational study evaluated unit and hospital-level factors affecting nurses' response to monitor desaturation alarms in postoperative patients on a general postoperative unit. With exemption and waiver of consent granted from the Institutional Review Board, monitoring data were downloaded from bedside monitors of postoperative patients. Alarm notification data and response times were recorded from the continuous capture of institutional surveillance data. Paging notifications were coded as clinically relevant (i.e., true oxygen desaturation with SpO2<89 for >15s) or irrelevant (i.e., artifact, inappropriate alarm threshold, or failure to delay page). Linear mixed models, and correlation coefficients were used to examine the relationships between unit staffing, shift, paging burden and response time. Means and [95% confidence intervals] are presented. Results: 1616 monitoring hours in 103 patients yielded 342 desaturation events (duration 23.6s [20.99, 26.1]) and 710 notification pages, 36% of which were for clinically relevant desaturation. Nursing response time was 52.1s [46.4, 57.7], which was longer at night (63.8 [51.2, 76.35]; p=0.035), but not related to unit staffing. Missed alarm events (i.e., no notification page transmitted) occurred for 26% of the clinically relevant events, and were associated with higher paging burden (p=0.04), lower SpO2 values (81.8 [80.5, 83.0] vs. 83.2 [82.6, 83.8]; p=0.026), and higher odds of intervention (OR 3.5 [1.38, 8.9]). 65% of patients with desaturation events received interventions which correlated with the number of pages (rho=0.422; p<0.01) and events (rho=0.57; p<0.01), desaturation duration (rho=0.505; p<0.01), and SpO2 (rho=-0.324; p<0.01). Conclusions: One-third of pulse oximetry alarm notifications were for clinically relevant oxygen desaturation, facilitating timely nursing response and intervention for most patients. Unit staffing and false alarm frequency were not associated with response time, suggesting a high level of attention on this unit. The nature and degree of missed alarm events suggests patient safety concerns posed by hospital-level transmission systems warranting further strategies to ensure monitoring safety.
    Full-text · Article · Mar 2013
    • "However, there is a large cohort of patients falling outside of these extremes, and this an area where evidence is needed to help guide management decisions. Of interest, implementing alarm-equipped continuous pulse oximetry monitoring in unselected surgical patients has been shown to reduce postoperative respiratory rescue events and intensive care transfers [60]. Supine positioning can worsen symptoms in patients with OSA and it has been shown that elevation of the head of the bed can increase stability of the airway [61]. "
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    Full-text · Article · Sep 2012
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