EFFECT OF ROUTINE EMERGENCY DEPARTMENT TRIAGE PULSE OXIMETRY SCREENING ON MEDICAL-MANAGEMENT

Purpose: To determine the utility of routine triage pulse oximetry scr eening in emergency department (ED) patients. Design: Prospective stud y using pulse oximetry to measure oxygen saturation of ED patients at triage. Saturation values were disclosed to physicians only after they completed medical evaluations and were ready to discharge or admit ea ch patient. We measured changes in medical management initiated after disclosure of pulse oximetry values. Setting and participants: The stu dy included 14,059 consecutive patients presenting to triage at a univ ersity ED. Measurements: Changes in select diagnostic tests: chest rad iography, CBC count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonis ts, supplemental oxygen; and hospital admission and final diagnoses th at occurred after disclosure of triage pulse oximetry values. Results: Of 1,175 patients having triage pulse oximetry values less than 95%, physicians ordered repeat pulse oximetry on 159 (13.5%), additional ch est radiography on 5.4%, CBC count on 3.1%, arterial blood gases on 2. 9%, spirometry on 0.9%, and ventilation-perfusion scans on 0.3%. Physi cians ordered 178 new therapies on 134 patients (11.4%), including sup plemental oxygen for 6.5%, antibiotics for 3.9%, and beta-agonists for 1.8%. Thirty-five patients (3.0%) initially scheduled for hospital di scharge were subsequently admitted. Physicians changed or added diagno ses in 77 patients (6.6%). Conclusions: Providing physicians with rout ine triage pulse oximetry measurements resulted in significant changes in medical treatment of these patients.