Reducing Excessive Continuous Pulse Oximetry and Promoting Patient Safety: An Electronic Health Record-Based Quality
Justin C Zhang1, Nirav R Bhakta2, Madeline Chicas3
1Department of Medicine, University of California San Francisco, San Francisco, CA, USA. jcenzhang@gmail.com.
Journal of General Internal Medicine
|July 16, 2026
Summary
An electronic health record (EHR)-based quality improvement initiative significantly reduced continuous pulse oximetry monitoring (CPO) hours and alarms. This EHR intervention safely decreased CPO utilization without increasing patient harm events.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Clinical Informatics
Background:
- Continuous pulse oximetry monitoring (CPO) is widely used but often overutilized in hospitals.
- Overutilization of CPO contributes to alarm fatigue and burdens healthcare staff.
- Appropriate CPO utilization is a critical national patient safety goal.
Purpose of the Study:
- To assess the effectiveness of an electronic health record (EHR)-based quality improvement (QI) initiative in reducing inpatient CPO.
- To determine if the QI intervention could safely decrease CPO monitoring.
Main Methods:
- A QI intervention was implemented across non-ICU units from June 2022 to May 2024.
- Interventions included revised CPO order sets and best practice advisories (BPAs) for timely discontinuation.
- Interrupted time series analysis compared CPO hours, alarms, and duration pre- and post-intervention.
Main Results:
- Monthly CPO hours decreased by 22,680 hours post-intervention (p < 0.01).
- Significant reductions were observed in monthly CPO alarms and CPO duration per admission.
- Intensive care unit (ICU) transfer rates increased slightly, but no significant changes occurred in rapid responses, code blue events, or mortality.
Conclusions:
- An EHR-based QI initiative effectively reduced continuous pulse oximetry monitoring utilization.
- Clinical decision support interventions can decrease CPO use without compromising patient safety.
- The study demonstrates a successful strategy for optimizing CPO monitoring in hospital settings.
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