Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T15:46:46.130Z Has data issue: false hasContentIssue false
  • English
  • Français

The Cost-Benefit of Pulse-Oximeter Use in the Prehospital Environment

Published online by Cambridge University Press:  28 June 2012

Andrew J. Macnab ,
Lark Susak ,
Faith A. Gagnon ,
Janet Alred  and
Charles Sun
Andrew J. Macnab*
Affiliation:
Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Ambulance Service
Lark Susak
Affiliation:
Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Ambulance Service
Faith A. Gagnon
Affiliation:
Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Ambulance Service
Janet Alred
Affiliation:
Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Ambulance Service
Charles Sun
Affiliation:
Division of Critical Care, Department of Pediatrics, University of British Columbia, British Columbia Ambulance Service
*
2L5 ICU Physicians' OfficeBC Children's Hospital 4480 Oak Street Vancouver, BC Canada E-mail: amacnab@cw.bc.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used.

Methods:

This was a prospective study conducted at 12 ambulance stations (average transport times >20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (oxygen-saturation measured by pulse oximetry) were then taken. If oxygen-saturation measured by pulse oximetry fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time.

Methods:

A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (oxygen-saturation measured by pulse oximetry < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20 / patient. Prehospital pulse-oximetry allows unncessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%).

Conclusion:

Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.

Keywords

ambulancecost-benefitcostshypoxemiaoximetryoxygen administrationparamedicsprehospitalpulse-oximeter use
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 14 , Issue 4 , December 1999 , pp. 41 - 46
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cydulka, RK, Shade, B, Emerman, CL et al. : Prehospital pulse-oximetry: Useful or misused? Ann Emer Med 1992;21:675–679.CrossRefGoogle ScholarPubMed
2. Helm, M, Lampl, L, Mutzbauer, T et al. : Semiquantitative capnometry: Helpful in verification of tube position in trauma patients? Unfalkhirurg 1996;99:11–16.Google ScholarPubMed
3. Ziegenfuss, T: Emergency management of polytrauma patients. Zentralbl Chir 1996;121:924–942.Google ScholarPubMed
4. Phillips, GD, Runciman, WB, Ilsley, AH: Monitoring in emergency medicine. Resuscitation 1989; 18 Suppl:S21–S35.CrossRefGoogle ScholarPubMed
5. Lambert, MA, Crinnion, J; The role of pulse-oximetry in the accident and emergency department. Arch Emerg Med 1989;6:211–215.CrossRefGoogle ScholarPubMed
6. Holburn, CJ, Allen, MJ: Pulse-oximetry in the accident and emergency department. Arch Emerg Med 1989;6:137–142.CrossRefGoogle ScholarPubMed
7. Mower, WR, Sachs, C, Nicklin, EL, Baraff, LJ: Pulse-oximetry as a fifth pediatric vital sign. Pediatrics 1997;99:681–686.CrossRefGoogle ScholarPubMed
8. Mower, WR, Sachs, C, Nicklin, EL, Safa, P, Baraff, LJ: Effect of routine emergency room triage pulse-oximetry screening on medical management. Chest 1995;108:1297–1302.CrossRefGoogle ScholarPubMed
9. Stewart, RD: Advances in prehospital immediate care. Resuscitation 1989;18 Suppl:S13–S20.CrossRefGoogle ScholarPubMed
10. Silverston, P: Pulse-oximetry at the roadside: A study of pulse-oximetry in immediate care. BJM 1989;298(6675):711–713.CrossRefGoogle ScholarPubMed
11. McGuire, TJ, Pointer, JE: Evaluation of a pulse-oximeter in the prehospital setting. Ann Emerg Med 1988;17:93–97.CrossRefGoogle ScholarPubMed
12. Aughley, K, Hess, D, Eitel, D et al. : A comparison of pulse-oximetry in the field. Ann Emerg Med 1989;19:460. (abstract)Google Scholar
13. Doubilet, P, Weinstein, MC, McNeil, BJ: Use and misuse of the term “cost-effective” in medicine. N Engl J Med 1986,31:253–256.CrossRefGoogle Scholar
14. Helm, M, Lampl, L, Forstem, K, Maier, B, Tisch, M, Bock, KH: Respiratory disorders in trauma patients. Pulse-oximetry as an extension of prehospital diagnosis and therapeutic possibilities. Unfalkhirurg 1991;94:281–286.Google ScholarPubMed
15. King, T, Simon, RH: Pulse-oximetry for tapering supplemental oxygen in hospitalized patients. Chest 1987;92:713–716.CrossRefGoogle ScholarPubMed
16. Akpunonu, B, Mutgi, A, Federman, D, Donabedian, H, Wasielewski, N, Lachant, M, Martin, G: Inappropriate use of oxygen: Loss of a valuable health care resource. Am J Med Sci 1994;308:244–246.Google Scholar