Results of a prospective trial of strategies for improving oxygen utilization

We prospectively investigated strategies for assuring that oxygen was provided to patients hospitalized in our institution, according to standard indications (Blue Cross/Blue Shield Medical Necessity Guidelines).

After a baseline observation period (Phase I) during which no specific interventions were made, therapists were informed that appropriate oxygen utilization was an administrative goal and a department priority, and intensive instruction and case review were provided by the Technical and Medical Directors (Phase II). In Phase III, therapists were encouraged to continue to assure that guidelines were met, but instruction, discussion, and review ceased, and the Technical Director assumed responsibility for all oxygen therapy decisions. Finally, all concerted policing activity by the Technical Director ceased (Phase IV).

The total number of patients and percentage of patients with no indications for therapy fell progressively through Phases II and III and returned almost to baseline after policing activities were discontinued in Phase IV.

We believe that it is unlikely that any department can sustain the educational and supervisory input necessary to assure optimal conformance to published standards for oxygen therapy when all members are involved. Therefore, assigning one qualified person to manage oxygen therapy may be more successful than other approaches. Requiring all therapists to monitor conformance to standards for low-flow oxygen therapy is time consuming and less effective and limits the time that can be spent caring for patients with problems that respond favorably to other forms of respiratory therapy.