Decreasing the Use of Continuous Pulse Oximetry in Pediatric Inpatients

Lavanya Shankar

Lavanya Shankar


As part of Choosing Wisely, the Society of Hospital Medicine (SOHM) recommends not using continuous pulse oximetry routinely (CPO) in children with acute respiratory illness unless they are on supplemental oxygen. CPO monitoring is the standard of practice at our facility for monitoring the patient’s clinical status and response to therapy. As a result many patients may be unnecessarily monitored and have prolonged hospitalization.  In our unit, oximetry alarms represent the most frequent non-actionable clinical alarm.  This project aimed to decrease the use of CPO with resultant decreases in length of stay (LOS), cost, and clinical alarms.


Rapid-cycle intervention design was used in an inpatient pediatric unit at a large community hospital. An interprofessional team was assembled to develop and implement a pediatric pulse oximetry protocol (POP). Protocol use and compliance were monitored.  Outcome measures included length of stay, cost, readmission, and alarm frequencies.   The protocol was revised after 18 months of measurement and added to the electronic medical system.


Overall decline in CPO order frequency with resultant upward trends in protocol order frequency.  Nurse protocol compliance increased following protocol revision (64% compared to 50 % with the initial protocol).  Average cost of hospitalization in the pre-intervention group was $19,262 and LOS 62 hours, compared to $14,843 and LOS 40 hours 2 years post. Only 1 protocol patient was readmitted.  Noted variable impact on oximetry alarm frequency.


Implementation of the POP, decreased use of CPO in hospitalized pediatric patients.  Downward trends in non-actionable (nuisance) oximetry alarms are expected as protocol compliance continues to increase. Proper use of the protocol contributes to decreases in cost and LOS without a resultant increase in readmissions.  However the true impact is overshadowed by variations in compliance.  Partnership with unit nursing leadership and individual performance monitoring continues to improve compliance.