Kellerman A L, Cofer C A, Joseph S, Hackman B B
Division of Emergency Medicine, University of Tennessee, Memphis.
Ann Emerg Med. 1991 Feb;20(2):130-4. doi: 10.1016/s0196-0644(05)81208-9.
To determine the impact of portable pulse oximetry on physician use of arterial blood gas tests (ABGs) in an urban emergency department.
Prospective, controlled clinical trial.
The ED of the Regional Medical Center at Memphis, a publicly subsidized, 450-bed, acute care hospital staffed by residents and faculty of the University of Tennessee, Memphis.
Rotating housestaff treating adult ED patients with a wide variety of medical and surgical problems.
Introduction of a portable pulse oximeter for noninvasive measurement of blood oxygenation.
Rates of ABG test ordering, housestaff reason(s) for ordering an ABG, and the incidence of adverse clinical outcomes before and after introduction of portable pulse oximetry.
A total of 20,120 patient visits occurred during the four-month study. Before oximeter introduction, emergency physicians ordered 699 ABGs, 63% of which were indicated by explicit criteria. After oximeter introduction, 440 ABGs were ordered (a 37% decrease). Almost all of this decrease was due to fewer ABGs ordered to assess oxygenation (260 before vs 75 after; chi 2, P less than .001). These reductions were not explained by differences in total patient visits or case mix. Physicians decreased ordering of indicated ABGs by almost as great an extent as they reduced ordering of unindicated tests, suggesting they did not consistently distinguish between the two. However, decreased testing did not result in any serious adverse outcomes, defined as unanticipated respiratory or cardiac arrest in the ED, unanticipated arrest on the floor within 24 hours of admission, or death within two days of hospital discharge.
Portable pulse oximetry can provide a simple, noninvasive way to determine oxygen saturation in the ED. Routine use of portable pulse oximetry may substantially reduce rates of ABG testing and associated patient charges without adversely affecting the quality of emergency care.
确定便携式脉搏血氧饱和度仪对城市急诊科医生使用动脉血气分析（ABG）检测的影响。
前瞻性对照临床试验。
孟菲斯地区医疗中心急诊科，这是一家由田纳西大学孟菲斯分校的住院医师和教员提供服务的、有450张床位的公立补贴急症医院。
轮转住院医师，负责治疗患有各种内科和外科问题的成年急诊科患者。
引入用于无创测量血液氧合的便携式脉搏血氧饱和度仪。
ABG检测的开具率、住院医师开具ABG检测的原因以及引入便携式脉搏血氧饱和度仪前后不良临床结局的发生率。
在为期四个月的研究期间，共发生了20120次患者就诊。在引入血氧饱和度仪之前，急诊医生开具了699次ABG检测，其中63%符合明确标准。引入血氧饱和度仪之后，开具了440次ABG检测（减少了37%）。几乎所有的减少都归因于为评估氧合而开具的ABG检测减少（之前为260次，之后为75次；卡方检验，P<0.001）。这些减少并非由总就诊患者数或病例组合的差异所解释。医生减少开具符合标准的ABG检测的程度几乎与减少开具不符合标准检测的程度相同，这表明他们并未始终如一地区分两者。然而，检测次数的减少并未导致任何严重不良结局，严重不良结局定义为急诊科意外呼吸或心脏骤停、入院后24小时内在病房意外骤停或出院后两天内死亡。
便携式脉搏血氧饱和度仪可为急诊科测定氧饱和度提供一种简单、无创的方法。常规使用便携式脉搏血氧饱和度仪可能会大幅降低ABG检测率及相关患者费用，而不会对急诊护理质量产生不利影响。
