No Cause for Alarm: Decreasing Inappropriate Pulse Oximetry Use in Bronchiolitis.

Abstract

“I need you to come look at the baby in room 8! The monitor keeps alarming for desaturations.” I walk to the patient room thinking through the many other tasks on my to-do list. As I enter the room, the smiling but noisy breathing child with bronchiolitis greets me. “We’ve deep suctioned him and he’s breathing more comfortably, but the pulse oximeter keeps dipping into the high 80s.” I look at the bedside monitor continuously tracking the patient’s heart rate, respiratory rate and oxyhemoglobin saturation, which now reads a perfect 100%. As I complete my assessment, I cannot help but wonder, “Why is this happy, well-appearing patient on a monitor?” As trainees, we are the frontline clinicians who rotate through different units within the hospital, and we observe situations like this almost every day, if not multiple times a day. Our perspective should make us the ideal stewards for identifying care processes that deviate from standard guidelines, but we are often not empowered to implement changes to improve the system and rather rely on the “higher-ups” to solve systems-based issues. As the call for “bending the value curve” has echoed through hospital systems and training programs, it is essential that we not only teach trainees about health care value but also empower them to identify examples of low-value care and give them tools and resources to be a more effective part of the solution.1 As part of the Hospital …