The cost-benefit of pulse-oximeter use in the prehospital environment.
BACKGROUND
Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used.


METHODS
This was a prospective study conducted at 12 ambulance stations (average transport times > 20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (SpO2) were then taken. If SpO2 fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time.


RESULTS
A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (SpO2 < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20/patient. Prehospital pulse-oximetry allows unnecessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%).


CONCLUSIONS
Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.
Macnab
A J
AJ
Department of Pediatrics, University of British Columbia, Canada. amacnab@cw.bc.ca
Susak
L
L
Gagnon
F A
FA
Alred
J
J
Sun
C
C
D000552:Ambulances; D001955:British Columbia; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D017048:Health Care Costs; D006801:Humans; D010092:Oximetry / Q000191:economics*; D011446:Prospective Studies