EHR-Integrated Monitor Data to Measure Pulse Oximetry Use in Bronchiolitis

Continuous pulse oximetry (oxygen saturation [Spo₂]) monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen is discouraged by national guidelines, but determining monitoring status accurately requires in-person observation. Our objective was to determine if electronic health record (EHR) data can accurately estimate the extent of actual Spo₂ monitoring use in bronchiolitis.

This repeated cross-sectional study included infants aged 8 weeks through 23 months hospitalized with bronchiolitis. In the validation phase at 3 children's hospitals, we calculated the test characteristics of the Spo₂ monitor data streamed into the EHR each minute when monitoring was active compared with in-person observation of Spo₂ monitoring use. In the application phase at 1 children's hospital, we identified periods when supplemental oxygen was administered using EHR flowsheet documentation and calculated the duration of Spo₂ monitoring that occurred in the absence of supplemental oxygen.

Among 668 infants at 3 hospitals (validation phase), EHR-integrated Spo₂ data from the same minute as in-person observation had a sensitivity of 90%, specificity of 98%, positive predictive value of 88%, and negative predictive value of 98% for actual Spo₂ monitoring use. Using EHR-integrated data in a sample of 317 infants at 1 hospital (application phase), infants were monitored in the absence of oxygen supplementation for a median 4.1 hours (interquartile range 1.4-9.4 hours). Those who received supplemental oxygen experienced a median 5.6 hours (interquartile range 3.0-10.6 hours) of monitoring after oxygen was stopped.

EHR-integrated monitor data are a valid measure of actual Spo₂ monitoring use that may help hospitals more efficiently identify opportunities to deimplement guideline-inconsistent use.