Abstract
OBJECTIVE: To determine the effect on arterial blood gas (ABG) and hospital resource use by introducing a strategy of using bedside oximeters with a clinical algorithm, based on the argument that bedside pulse oximeters make economic sense in the intensive care unit (ICU) if safe patient oxygenation can be ensured at a lower cost than that of existing monitoring options.DESIGN: A before and after design was used to examine the consequences of a pulse oximeter at each bedside in the ICU along with a pulse oximeter clinical algorithm (POCA) describing use for titrating oxygen therapy and for performing ABG analysis.SETTING: A 19‐bed multidisciplinary ICU with a six‐bed extended ICU (EICU) available to function as a ′step‐down′ facility.PATIENTS: All patients admitted to the ICU/EICU over two 12‐month periods were included.RESULTS: The strategy yielded a 31% reduction in the mean number of ABGs per patient after POCA (20.0±26.1 versus 13.8±16.7, mean ± SD; P<0.001) as well as a potential annual cost savings of $32,831.CONCLUSIONS: Bedside oximeters within the ICU, when used with explicit guidelines, reduce ABG use and result in hospital cost savings.
Highlights
Pulse oximetry has two advantages over clinical signs and intermittent arterial blood gas (ABG) analysis: first, it can act as a warning system for detecting hypoxemia, with the potential to prevent the adverse patient consequences of arterial desaturation; and second, it can be used as an end-point for the titration of inspired oxygen (FIO2) and positive end-expiratory pressure (PEEP), serving as a response indicator
With these advantages in mind, we introduced a strategy of using bedside oximeters with a clinical algorithm in our intensive care unit (ICU) to determine the effect on ABG and hospital resource use
We found a 31% reduction in ABG use in our ICU following the introduction of bedside pulse oximeters when used with explicit guidelines
Summary
To determine the effect on arterial blood gas (ABG) and hospital resource use by introducing a strategy of using bedside oximeters with a clinical algorithm, based on the argument that bedside pulse oximeters make economic sense in the intensive care unit (ICU) if safe patient oxygenation can be ensured at a lower cost than that of existing monitoring options. Pulse oximetry has two advantages over clinical signs and intermittent ABG analysis: first, it can act as a warning system for detecting hypoxemia, with the potential to prevent the adverse patient consequences of arterial desaturation; and second, it can be used as an end-point for the titration of inspired oxygen (FIO2) and positive end-expiratory pressure (PEEP), serving as a response indicator With these advantages in mind, we introduced a strategy of using bedside oximeters with a clinical algorithm in our ICU to determine the effect on ABG and hospital resource use. From August 1, 1992 to July 31, 1993, each bedside within the ICU had its own oximeter (Hewlett Packard Component Monitoring System with M1020A oxygen saturation modules, Hewlett Packard, Massachusetts) and the five shared units were used in the six-bed EICU; a pulse oximeter clinical algorithm (POCA) describing oximeter use for titrating oxygen therapy and for performing ABG analysis was included (Figure 1).
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