763 - Provider Perception and Decision Making Regarding Continuous Cardiopulmonary Monitors

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 763
Publication Number: 763.415

Sara M. Touzinsky, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Amanda Schondelmeyer, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Hadley Sauers-Ford, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Matthew J. Molloy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katy Bedinghaus, Cincinnati Children's Hospital Medical Center, Cleves, OH, United States; Patrick W.. Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Maria Britto, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States; Maria Cvach, Johns Hopkins Health System, Baltimore, MD, United States; Samir S. Shah, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Lisa M. Vaughn, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; James Won, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, United States; Kathleen E. Walsh, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Sara M. Touzinsky, MD (she/her/hers)

Pediatric Resident
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Background: There is significant variation in the use of continuous cardiopulmonary monitors (CPM) across institutions with similar acuity suggesting factors such as physician preference and hospital culture as likely contributors.

Objective: We sought to explore how residents, attendings, nurses (RN) and respiratory therapists (RT) make decisions on the use of cardiopulmonary and pulse oximetry monitors in hospitalized children.

Design/Methods: We conducted a qualitative study using semi-structed interviews with RNs, RTs, residents, and attending physicians from a hospital medicine unit at a large children’s hospital. The interview guide inquired about decision making around continuous CPM with detailed patient scenarios in addition to open-ended questions to facilitate a cognitive walkthrough. Using an inductive, thematic approach, each interview was coded independently by two study team members with disagreements referred to a third. Using these codes, we identified emerging themes and illustrative quotes.

Results: We interviewed 5 RNs, 5 RTs, 7 resident physicians, and 7 attending physicians. Participants were predominantly female (22/24, 92%), and there was a range of experience levels (Table 1). The overarching theme was a lack of specific rationale about why patients were monitored and poor team communication surrounding monitors (Table 2). Clinicians perceived a low threshold to start monitors but a high threshold to stop them. Monitors are seen as the default, especially when a member of the team is worried, or the child’s story is unclear. Clinicians expressed that monitors function to assess patient stability and that benefits outweigh the risk, although they also came with downsides such as alarm fatigue. Additionally, clinicians perceived that monitors would capture deterioration if providers were not present, and they felt more at ease when patients were on monitors. Clinicians also shared that there was no standard process for discontinuing monitors, meaning that patients may be left on continuous monitors when the medical team no longer perceived them to be useful.

Conclusion(s):

We concluded that nurses, physicians, and respiratory therapists default to CPM use, cite non-specific reasons for CPM use, and note a lack of a standardized means to discontinue monitors. CPM was seen as a tool for early detection of deterioration, despite the recognition that monitors may be associated with negative effects. These themes demonstrate the value of developing and implementing clinical pathways and evidence-based guidelines.