title: Quality improvement in screening for critical congenital heart disease.
abstract: OBJECTIVE
  Screening for critical congenital heart disease with pulse oximetry requires healthcare providers to decipher a previously published algorithm, a feature that raises concerns about quality of interpretation of pulse oximetry results. We hypothesized that this method would be prone to error and a computer-based tool would lead to a more accurate interpretation of the screening results.
  
  
  METHODS
  In this randomized crossover study, healthcare providers with prior experience using pulse oximetry received 2 sets of 10 mock screening scenarios and were asked to interpret the results of each scenario as "pass," "fail," or "retest." Participants were randomized to use either the paper algorithm or computer-based tool for the first set of 10 scenarios and the alternative method for the second set. We used Wilcoxon rank sum tests to compare the accuracy of interpretation using the 2 methods.
  
  
  RESULTS
  The 102 participants answered 81.6% of the scenarios correctly when manually interpreting the algorithm vs 98.3% correct when using the computer-based tool (P < .001). These differences were most pronounced for the "fail" scenarios (65.4% manual vs 96.7% computer, P < .001) and the "retest" scenarios (80.7% manual vs 98.7% computer, P < .001), but were also significant for the "pass" scenarios (94.1% manual vs 99.0% computer, P < .001).
  
  
  CONCLUSIONS
  Use of a manual algorithm for the interpretation of results in screening for critical congenital heart disease with pulse oximetry is susceptible to human error. Implementation of a computer-based tool to aid in the interpretation of the results may lead to improved accuracy and quality.
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Emory University Rollins School of Public Health, Atlanta, GA. Electronic address: osterm@kidsheart.com.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA; Emory University Woodruff School of Nursing, Atlanta, GA; Children's Medical Center, Dallas, TX.
authors.forename: Kristina W
authors.initials: KW
authors.lastname: Kuo
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D000465:Algorithms; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D010092:Oximetry; D058996:Quality Improvement; D015203:Reproducibility of Results
keywords: CCHD; Critical congenital heart disease