THE OXYGEN SCRIPT TEST: DOES EVERYONE NEED IT?

ABSTRACT

SESSION TITLE Actionable Improvements in Safety and Quality SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/17/2022 1215 pm - 115 pm PURPOSE: Hypoxemia is common amongst hospitalized patients with Chronic Obstructive Pulmonary disease (COPD), Pulmonary Hypertension (PH), Interstitial Lung disease (ILD) and Congestive heart failure (CHF). At discharge, these patients are evaluated for home oxygen using an oxygen prescription test. This test entails evaluating the patient for hypoxemia at rest or while walking for a maximum duration of 6 minutes. This project aims to evaluate the ordering practices of oxygen prescription test at Allegheny General Hospital and adherence to guidelines set by Center for Medicaid Services. We hope to identify a threshold resting oxygen saturation that is not associated with desaturation requiring oxygen supplementation, and identify patient characteristics that are associated with these desaturations. METHODS: We performed a retrospective review of patients who underwent an oxygen prescription test from January-March 2021. The variables studied included demographic details, co-morbidities as well as results of the test. Desaturation was defined as a drop in oxygen saturation to ≤ 88%. We analyzed if any of these variables affected the outcome of the test. RESULTS: One hundred and ninety-eight oxygen prescription tests were performed of which 168 tests were valid and utilized for analysis. Fifty three percent of these patients were female and the median BMI was 31. About 32% of these patients had COPD, 2% had ILD, 35% had PH, 50% had CHF and 15% had Covid-19. The median age was significantly higher in patients with an oxygen requirement at hospital discharge (median = 68.5 yrs., IQR = 15) than in patients without an oxygen requirement (median = 64 yrs., IQR = 20) (p =.036). Resting saturation was significantly lower in patients with an oxygen requirement at hospital discharge (median = 91, IQR = 6) than in patients without an oxygen requirement (median = 94.5, IQR = 4) (p <.001). An ROC showed resting saturation was significant in predicting patients who would be discharged on home oxygen with an AUC of 0.832. More patients with PH had an oxygen requirement at discharge (42%) than did patients without PH (23%), odds ratio = 2.436, 95 CI, 1.24 - 4.77. CONCLUSIONS: About 15% of the tests performed had to be terminated prior to completion of the test - insurance companies could deny claims for costs arising as a consequence of these tests. We identified that resting saturation and pulmonary hypertension were most likely to predict the need for oxygen requirement on discharge. A resting saturation of about 91% was identified as the median for patients requiring oxygen on discharge. CLINICAL IMPLICATIONS Each study cost about 364$ and entails a significant amount of time to be invested by the care teams involved. By identifying patients who are likely to desaturate, we may be able to decrease the number of time consuming and resource intensive tests, improving patient satisfaction and overall quality of care. DISCLOSURES No relevant relationships by Marvin Balaan No relevant relationships by Deeksha Ramanujam No relevant relationships by Sheldon Rao no disclosure on file for Diane Thompson;