Continuous pulse oximetry monitoring may benefit patients

AORN Journal,  Sept, 2003  

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Continuous pulse oximetry monitoring may reduce costs by nearly 50% for patients who undergo cardiothoracic surgery and are readmitted to the intensive care unit (ICU) from a general care area, according to a June, 4, 2003, news release from Nellcor, a division of Tyco Healthcare. Researchers from the University of Pennsylvania conducted a study of 1,000 patients who randomly were selected to receive continuous pulse oximetry monitoring or standard intermittent pulse oximetry monitoring. Complete data was available for 989 of the participants. Of these patients, 85% underwent cardiothoracic surgery, and most were admitted to the general care floor after a postoperative stay in the ICU. Costs were determined

* at discharge to a non-ICU location (eg, home),

* at transfer to a higher acuity area (eg, the ICU), and

* from entry through discharge from the ICU.

For patients with ICU stays, costs were compared between patients who returned to the general care floor (ie, ICU survivors) and those who were not returned to the general care floor (ie, ICU nonsurvivors).

For patients who were not transferred to the ICU, costs for the study were comparable for the continuously monitored and intermittently monitored groups. Costs for patients readmitted to the ICU, however, were lower for the group that received continuous monitoring. Costs for ICU survivors were $29,400 for the continuously monitored group compared to $48,600 for the intermittently monitored group. Costs for nonsurvivors were $51,400 for the continuously monitored group compared to $82,100 for the intermittently monitored group.

In this study, fewer patients who received continuous pulse oximetry monitoring were transferred to the ICU for respiratory diagnoses. This may predict fewer ventilator days and other savings that could account for the cost reduction for continuously monitored patients transferred to the ICU. The researchers concluded that continuous pulse oximetry monitoring of patients who undergo cardiothoracic surgery after admission to a general care area from the OR, postanesthesia care unit, or ICU is associated with reduced cost. This potential cost reduction is seen in patients who are readmitted to higher acuity areas, especially the ICU. The researchers noted, however, that cost savings were not offset by increased costs associated with continuous pulse oximetry monitoring in large numbers of patients.

Examination

Pain management--Continuum
of care for surgical patients

 1. The process improvement strategy
    used for this project included all of
    the following except
    a. finding a process that needs
       improvement.
    b. organizing a project team.
    c. comprehending, understanding,
       and strengthening the process.
    d. clarifying, understanding, and
       stabilizing the process.

 2. The -- cycle ensures that the
    situation is adequately assessed, a
    plan is determined and implemented,
    the results are evaluated, and
    the improvement is standardized.
    a. APES
    b. SDRI
    c. PPSS
    d. PDSA

 3. Having different pain management
    clinical practices for two separate
    anesthesia groups resulted in conflicting
    routines for nurses.
    a. true
    b. false

 4. Staff member knowledge and competency
    in regard to pain management
    needed to be enhanced in all
    of the following areas except
    a. pain scales.
    b. psychological responses to pain.
    c. sedation scales.
    d. pharmaceutical implications.

 5. To analyze content and the flow of
    information for six measurement
    standards, learn members
    a. reviewed research literature.
    b. performed time-sensitive interviews
    of key individuals.
    c. performed medical record chart
    audits.
    d. prepared time-line diagrams.

 6. To heighten awareness and stay
    abreast of changes in clinical practices
    regarding pain management,
    the surgical services division
    a. provided monthly inservice programs
       regarding commonly used
       pain medications.
    b. elected to make January a pain
       management awareness month
       annually.
    c. cross trained all OR personnel to
       work in phase II recovery.
    d. cross trained all phase II recovery
       personnel to work in the OR.

 7. The goal of developing postoperative
    standing orders and protocols
    was to have both anesthesia groups
    responsible for the management of
    patients' comfort and pain postoperatively
    to the point of discharge
    from the phase 11 postanesthesia
    care unit (PACU).
    a. true
    b. false

 8. The preformatted standing order
    sets allowed anesthesia care
    providers to select medications
    based on all of the following except
    a. previous surgical history.
    b. procedure and anesthesia administered.
    c. medical history.
    d. other medications administered
       before arrival in the PACU.

 9. The equianalgesic reference chart
    was developed to
    a. safeguard against errors in medication dosing.
    b. ensure that nonphysician health
    care providers consistently order
    appropriate medications and
    doses.
    c. safe guard against errors in medication
    administration.
    d. encourage care providers to consider
    alternatives for pain management.

10. The pain management process
    improvement project accomplished
    all of the following goals
    except
    a. improved continuum of care delivered
    between facilities.
    b. increased staff member compliance
    with attending pain management
    education sessions.
    c. improved communication between
    departments and health
    care team members.
    d.100% use of standing orders at
    both facilities.