Intermittent Pulse Oximetry Use and Length of Stay in Bronchiolitis: Bystander or Primary Driver?

Abstract

Bronchiolitis has been a prominent focus for quality improvement (QI) efforts in pediatrics for nearly 2 decades.1 Bronchiolitis costs the US health care system an estimated $1.7 billion annually, and numerous efforts from the local institutional to national levels have been undertaken to promote high-value care and reduce unnecessary resource use.2,3 Pulse oximetry use in bronchiolitis is a perennial target for improvement efforts based on the impact of its use on the risk of hospitalization and length of stay (LOS) without appreciable improvements in patient outcomes.4 Studies of pulse oximetry’s impact on LOS have been previously focused on either the widely varying lower acceptable limit of oxygen saturation or the use of continuous versus intermittent pulse oximetry (IPO).4–6 In this issue of Hospital Pediatrics , Mittal et al7 present results from a QI initiative that both standardized pulse oximetry value interpretation and increased the use of IPO over continuous pulse oximetry (CPO). They demonstrated that their combined approach was associated with a reduction of hospital LOS in a community hospital setting. The retrospective baseline cohort of 180 patients was compared with 2 intervention cohorts of 94 patients and 99 patients in cycles 1 and 2, respectively. In cycle 1, IPO use increased from a baseline of 20% to 75% while …