Cargando…

Impact of oxygen therapy algorithm on oxygen usage in the emergency department

BACKGROUND: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. MATERIALS AND METHODS: This prospective observational study was done in a large emergency department (ED) in I...

Descripción completa

Detalles Bibliográficos
Autores principales: Abhilash, KPP, Acharya, H, Dua, J, Kumar, S, Selvaraj, B, Priya, G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542065/
https://www.ncbi.nlm.nih.gov/pubmed/32675448
http://dx.doi.org/10.4103/jpgm.JPGM_637_19
_version_ 1783591483859795968
author Abhilash, KPP
Acharya, H
Dua, J
Kumar, S
Selvaraj, B
Priya, G
author_facet Abhilash, KPP
Acharya, H
Dua, J
Kumar, S
Selvaraj, B
Priya, G
author_sort Abhilash, KPP
collection PubMed
description BACKGROUND: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. MATERIALS AND METHODS: This prospective observational study was done in a large emergency department (ED) in India. The pattern of oxygen usage was studied before and after the strict implementation of an oxygen treatment algorithm. The algorithm was taught to all doctors and nurses and its implementation was monitored regularly. The main outcome measures were proportion of patients receiving oxygen therapy, inappropriate usage, and avoidable direct medical cost to the patient. RESULTS: The 3-week pre-protocol observation phase in April 2016 included 3769 patients and the 3-week post-protocol observation phase in April 2017 included 4608 patients. The baseline demographic pattern was similar in both the pre-protocol and post-protocol groups. After the strict implementation of the algorithm, the number of patients receiving oxygen therapy decreased from 9.63% to 4.82%, a relative decrease of 51.4%. The average amount of total oxygen used decreased from 55.4 liters per person in pre-protocol group to 42.1 liters per person in the post-protocol group with a mean difference of 13.28 (95% CI 5.30-21.26; P = 0.001). Inappropriate oxygen usage decreased from 37.2% to 8.6%. There was a significant decrease in inappropriate oxygen use for indications like low sensorium (60.8% vs 21.7%) and trauma (88.5% vs 15.8%). The mortality rate in the pre-protocol phase was 2.7% as compared with 3.2% in the post-protocol phase. The total duration of inappropriate oxygen usage significantly decreased from 987 h to 89 h over the 21-day study period. CONCLUSION: The implementation of an oxygen therapy algorithm significantly reduces inappropriate oxygen use and decreases treatment cost to the patient with no additional mortality risk.
format Online
Article
Text
id pubmed-7542065
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-75420652020-10-20 Impact of oxygen therapy algorithm on oxygen usage in the emergency department Abhilash, KPP Acharya, H Dua, J Kumar, S Selvaraj, B Priya, G J Postgrad Med Original Article BACKGROUND: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. MATERIALS AND METHODS: This prospective observational study was done in a large emergency department (ED) in India. The pattern of oxygen usage was studied before and after the strict implementation of an oxygen treatment algorithm. The algorithm was taught to all doctors and nurses and its implementation was monitored regularly. The main outcome measures were proportion of patients receiving oxygen therapy, inappropriate usage, and avoidable direct medical cost to the patient. RESULTS: The 3-week pre-protocol observation phase in April 2016 included 3769 patients and the 3-week post-protocol observation phase in April 2017 included 4608 patients. The baseline demographic pattern was similar in both the pre-protocol and post-protocol groups. After the strict implementation of the algorithm, the number of patients receiving oxygen therapy decreased from 9.63% to 4.82%, a relative decrease of 51.4%. The average amount of total oxygen used decreased from 55.4 liters per person in pre-protocol group to 42.1 liters per person in the post-protocol group with a mean difference of 13.28 (95% CI 5.30-21.26; P = 0.001). Inappropriate oxygen usage decreased from 37.2% to 8.6%. There was a significant decrease in inappropriate oxygen use for indications like low sensorium (60.8% vs 21.7%) and trauma (88.5% vs 15.8%). The mortality rate in the pre-protocol phase was 2.7% as compared with 3.2% in the post-protocol phase. The total duration of inappropriate oxygen usage significantly decreased from 987 h to 89 h over the 21-day study period. CONCLUSION: The implementation of an oxygen therapy algorithm significantly reduces inappropriate oxygen use and decreases treatment cost to the patient with no additional mortality risk. Wolters Kluwer - Medknow 2020 2020-06-25 /pmc/articles/PMC7542065/ /pubmed/32675448 http://dx.doi.org/10.4103/jpgm.JPGM_637_19 Text en Copyright: © 2020 Journal of Postgraduate Medicine http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Abhilash, KPP
Acharya, H
Dua, J
Kumar, S
Selvaraj, B
Priya, G
Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title_full Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title_fullStr Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title_full_unstemmed Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title_short Impact of oxygen therapy algorithm on oxygen usage in the emergency department
title_sort impact of oxygen therapy algorithm on oxygen usage in the emergency department
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542065/
https://www.ncbi.nlm.nih.gov/pubmed/32675448
http://dx.doi.org/10.4103/jpgm.JPGM_637_19
work_keys_str_mv AT abhilashkpp impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment
AT acharyah impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment
AT duaj impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment
AT kumars impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment
AT selvarajb impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment
AT priyag impactofoxygentherapyalgorithmonoxygenusageintheemergencydepartment