title: Using quality improvement to reduce continuous pulse oximetry use in children with wheezing.
abstract: OBJECTIVE
  Clinicians commonly use continuous pulse oximetry (CPOx) for hospitalized children with respiratory illnesses. The Choosing Wisely initiative recommended discontinuing CPOx for children on room air. We used quality improvement methods to reduce time on CPOx in patients with wheezing.
  
  
  METHODS
  Our project took place on 1 unit of a children's hospital. We developed consensus-based criteria for CPOx discontinuation. Interventions included education, a checklist used during nurse handoff, and discontinuation criteria incorporated into order sets. We collected data on a second unit where we did not actively intervene to assess for secular trends and negative consequences of shorter monitoring. We followed time until medically ready, ICU transfers, hospital revisits, and medical emergency team calls on both units. We tracked the impact of interventions by using run charts and statistical process control charts.
  
  
  RESULTS
  Median time per week on CPOx after meeting goals decreased from 10.7 hours to 3.1 hours on the intervention unit. Median time per week on CPOx on the control unit decreased from 11.5 hours to 6.9 hours. There was no decrease in time until medically ready on either unit. The percentage of patients needing transfer, revisit, or medical emergency team call was similar on both units.
  
  
  CONCLUSIONS
  With interventions focused on clarity and awareness of CPOx discontinuation criteria, we decreased time on CPOx; however, we saw no impact on time until medically ready. We expect that other centers could use analogous methods to standardize and reduce oxygen monitoring to meet Choosing Wisely recommendations.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, amanda.schondelmeyer@cchmc.org.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Schondelmeyer
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, James M. Anderson Center for Health Systems Excellence.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Simmons
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Statile
authors.affiliation: Center for Telehealth, and.
authors.forename: Kelsey E
authors.initials: KE
authors.lastname: Hofacer
authors.affiliation: Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith
authors.affiliation: Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Lori
authors.initials: L
authors.lastname: Prine
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, James M. Anderson Center for Health Systems Excellence.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D001249:Asthma / Q000097:blood* / Q000175:diagnosis*; D001988:Bronchiolitis / Q000097:blood / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D009820:Ohio; D010092:Oximetry / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012135:Respiratory Sounds / Q000175:diagnosis*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: asthma; bronchiolitis; health resources; hospital medicine