Sustainment of continuous pulse oximetry deimplementation: Analysis of Eliminating Monitor Overuse study data from six hospitals

Using continuous pulse oximetry (cSpO(2)) to monitor children with bronchiolitis who are not receiving supplemental oxygen is a form of medical overuse. In this longitudinal analysis from the Eliminating Monitor Overuse (EMO) study, we aimed to assess changes in cSpO(2) overuse before, during, and after intensive cSpO(2)-deimplementation efforts in six hospitals. Monitoring data were collected during three phases: P1 baseline, P2 active deimplementation (all sites engaged in education and audit and feedback strategies), and P3 sustainment (a new baseline measured after strategies were withdrawn). Two thousand and fifty-three observations were analyzed. We found that each hospital experienced reductions during active deimplementation (P2), with overall adjusted cSpO(2) overuse decreasing from 53%, 95% confidence interval (CI): (49-57) to 22%, 95% CI: (19-25) between P1 and P2. However, following the withdrawal of deimplementation strategies, overuse rebounded in all six sites, with overall adjusted cSpO(2) overuse increasing to 37%, 95% CI: (33-41) in P3.

Automated summary

Using continuous pulse oximetry (cSpO2) to monitor children with bronchiolitis without supplemental oxygen is excessive medical use. In this study, six hospitals engaged in deimplementation efforts to reduce cSpO2 overuse. Results showed a decrease in cSpO2 overuse during active deimplementation, but a rebound in overuse after strategies were withdrawn.