Cut delays by 50 minutes with triage pulse oximetry
Cut delays by 50 minutes with triage pulse oximetry
Impact on ED flow is dramatic
Most ED nurses don't measure pulse oximetry levels at triage, but this assessment can have a dramatic impact on patient flow, says a new study. Researchers found that length of stay for bronchiolitis patients in a pediatric ED decreased by 50 minutes after pulse oximetry was implemented at triage.1
At Children's Hospital Los Angeles, respiratory, cardiac, and early sepsis patients now have a pulse oximetry check performed by ED nurses, regardless of findings on the triage exam.
Previously, to get a pulse oximetry level performed, the resident saw the patient, presented the findings to the attending, and wrote the order, says Ilene Claudius, MD, assistant professor and director of quality improvement for the Division of Emergency Medicine. Subsequently, an ED nurse needed to pick up the patient, get the probe out of the locked automated medication dispenser, identify the patient, get a reading, and communicate this to the resident, Claudius says.
"This was time-consuming, and there was a lot of opportunity for breakdown in the system," she says. "Also, knowing if a patient is hypoxic during triage and appropriately triaging them to the ED has reduced the need for urgent care to roll over patients to the ED."
In addition, a decision can be made to admit the patient earlier if nurses know the patient has a low pulse oximetry reading, says Claudius. If the patient's pulse oximetry is below 95%, the acuity rating is increased regardless of work of breathing and respiratory rate, says Inge Morton, RN, CPN, manager of education for the ED at Children's Hospital in Los Angeles. "Therefore, patients whose oxygenation is compromised are evaluated by a physician sooner," she says. "It is one more piece of data to help make the right decision on acuity and provide timely treatment."
The triage nurse can decide to check a pulse oximetry level at any time, regardless of what the chief complaint is, adds Morton. "Pneumonia can present as abdominal pain in children," she says. "If the nurse suspects that the chief complaint might not be the actual problem but has potentially a respiratory component, a pulse oximetry reading would help to discern this."
ED nurses need to recognize which patients need a pulse oximetry done, says Claudius. Even patients without overt lung findings on exam should be checked if they have a history of pulmonary or cardiac issues, or recent respiratory symptoms such as cough or wheezing, she says.
One potential concern is the triage nurse being lulled into a false sense of security by a normal pulse-oximetry reading. "If he or she feels the patient is in respiratory distress, this needs to be taken seriously even if the reading is normal," says Claudius.
However, researchers also found that about one-fourth of hypoxemic children had no overt signs of respiratory distress. "It's helpful to pick up these children early as well," says Claudius. "Since this is just a quick spot check, we have seen some falsely low readings in the younger infants. We usually make a point to repeat these with the infant oxygen probe while checking for pulse correlation before acting on the triage reading."
Reference
- Choi J, Claudius I. Decrease in emergency department length of stay as a result of triage pulse oximetry. Ped Emerg Care 2006; 22:412-414.
Sources
For more information about pulse oximetry at triage, contact:
- Ilene Claudius, MD, Director of Quality Improvement, Division of Emergency Medicine, Children's Hospital, 4650 Sunset Blvd., Los Angeles, CA 90027. E-mail: [email protected].
- Inge Morton, RN, CPN, Manager, Education, Emergency Department, MS 74, Children's Hospital, 4650 Sunset Blvd., Los Angeles, CA 90027. Telephone: (323) 660-2450, ext 4455. E-mail: [email protected].
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