- Bonafide CP, et al. JAMA. https://bit.ly/3dzLXnB
Some hospitals regularly use pulse oximetry to monitor children with bronchiolitis despite experts discouraging the practice, according to a new study.
Care for bronchiolitis, the top cause of hospitalization among infants, is primarily supportive. AAP clinical practice guidelines say clinicians may choose not to perform continuous pulse oximetry monitoring as there is more benefit than harm in not monitoring (https://bit.ly/2WwMWpb). The Society of Hospital Medicine Choosing Wisely guidelines go further, saying it should not be used for patients who are not on oxygen (https://bit.ly/3dqO1G2).
"We all have a tendency to believe that continuous monitoring is something that is always going to provide benefit and safety, and unfortunately that isn't the case," author Christopher P. Bonafide, M.D., M.S.C.E., FAAP, said in a news release. "When you monitor patients unnecessarily, it creates risk not only for that patient, in terms of longer hospital stays and increased costs, but also for the entire unit due to the potential for alarm fatigue.”
To see how often hospitals were using pulse oximetry, Dr. Bonafide and colleagues observed 3,612 patients with bronchiolitis and were not receiving supplemental oxygen at 56 hospitals in the U.S. and Canada. Patients ages 8 weeks through 23 months were observed from Dec. 1, 2018 through March 31, 2019.
After risk standardization, use ranged from 6% to 82% with a mean of 46%, according to the study.
Raw figures show median pulse oximetry use of 40% at freestanding children’s hospitals, 58% at children’s hospitals within hospitals and 48% at community hospitals.
Children who were 8 weeks to 5 months of age and born preterm were at significantly higher odds of being monitored compared to those 18-23 months and not preterm. Children with apnea, cyanosis or enteral feeding tubes also were more likely to be monitored.
"We were surprised by the huge amount of variation we saw across the hospitals in this study, which shows many institutions are using monitoring unnecessarily as a safety net," Dr. Bonafide said. "This study represents an essential first step in phasing out an overused, low-value care practice."