2001 OPEN FORUM Abstracts
Clinicians QuicklyLearn to Utilize Improved Accuracy and Reliability of the new generation ofpulse Oximeters
Stephanie K. Rostow, RRT, LeadTherapist, Charles G. Durbin, Jr., MD, Professor of Anesthesiology and Surgery,University of Virginia Health System, Charlottesville, Virginia
During a prospective study of theimpact of improved oximetry on clinical practice, we found that caregivers morerapidly weaned cardiac surgery patients from a high FiO2 (as wellas obtaining fewer ABGs), when they had access to data from a Masimo SET® Oximeter(MSO) as compared to a conventional pulse oximeter (CPO) (Ohmeda 3740). [1,2].We demonstrated that data from the MSO was more reliable than that from CPO,with less oximeter failure and ?down time?, however, this information was notavailable to caregivers during the study. In an attempt to see how this changewas ?learned?, we studied the change in weaning speed over time during the study.
Methods: After obtainingconsent, 86 adult patients were studied following CABG. On arrival in the ICU,both a CPO and a MSO were attached to the same hand of each patient and theoutput from both monitors continuously. Patients were randomly assigned to havethe display of only one of the devices available to the bedside caregivers withthe other device ?blinded?. No other clinical interventions were altered. Noinformation about the expected or actual performance of the MSO was providedto caregivers at any time. We determined the time until weaning to FiO2= 0.4, until extubation, and number of ABGs. We compared the first 30 patientsenrolled to the last 30. The weaning time with the CPO was used as control timefor comparison (100%).
Results: There was no differencein the demographics of the patients between any group. In the first 30 patients,there was a small (insignificant) difference with the MSO patients who weanedin 83% of the time of CPO patients. Of the last 30, those with the MSO weanedin 32% of CPO weaning time (p=<.05). There were fewer ABGs during weaningwith the MSO over the entire study (2.7± 1.2 vs. 4.1 ± 1.6 MSO vs. CPO; p<0.001)but this difference did not change over time.
Conclusions: This study showsthat clinicians learned to identify better monitoring technology. This experimentaldesign (randomized patients and blinded clinicians) is a powerful method toevaluate the impact of new technology. The demonstration of a positive changein behaviour over time is strong support for the idea that evaluation and learningare taking place. We suggest that this is a better way to study and evaluateinnovation and improvements in technologies in a clinical domain.