Clinical Decision Support for Pediatric Home Pulse Oximetry Orders

Objective: Home pulse oximetry is often prescribed to children with chronic disease upon hospital discharge. Children monitored at home may generate >20 alarms every 8 hours, contributing to premature discontinuation of monitoring. We aimed to improve the home oximetry ordering process using clinical decision support (CDS), supporting more liberal oxygen saturation (SpO 2 ) alarm limits. Methods: Within a large single-center improvement project to increase informativeness of alarms in the hospital and in patients’ homes, we compared home care oximetry orders of discharged children pre-post CDS implementation. Order parameters included low SpO 2 limit, specification of intensity of use, an intervention plan, pulse oximetry probe prescription, and order completeness. We extracted order details 6 months pre-CDS and 6 months post-CDS with a one-month washout period. The CDS intervention used a letter template to include all required home oximeter order elements and provide more liberal age-specific default alarm limits. Results: There were 100 orders in the pre-CDS epoch (7/1/2021-12/31/2021) and 112 orders in the post-CDS epoch (2/1/2022-7/31/2022). The median low SpO 2 alarm limit post-CDS implementation (87%, IQR 87%-90%) was significantly lower than pre-CDS (90%, IQR 90%-90%, p=<0.001). In the post-CDS epoch significantly more orders included an intervention plan (80.4% versus 31%, p<0.001), prescribed pulse oximeter probes (85.7% versus 52.0%, p<0.001), and were complete (68.8% versus 13.0%, p<0.001). Conclusions: CDS implementation resulted in a significant decrease in median low SpO 2 limit and a significant increase in home oximetry order completeness. These changes may decrease home oximetry alarm burden and improve caregiver experiences with home oximetry.