CT Area Hospitals Set and Meet Strict Monitoring Standards

Ralph A. Epstein, M.D.

In the December, 1986 issue of the APSF Newsletter, we reported that in November, 1985, the chiefs of anesthesiology of the 13 hospitals in the Hartford, Connecticut region met and agreed to a policy statement promulgating as a standard of care the use of pulse oximetry for all anesthetized patients and recovery room patients and, also, the use of capno8raphy during general anesthesia. At that time, only a minority of the hospitals in the region were making significant use of these monitoring modalities. The anesthesiology chiefs believed that a uniform and public policy would help them acquire the equipment they thought was needed.

To determine the magnitude of the improvement in safety monitoring ability in the year following the meeting, a survey was done of the 1 3 hospitals. The chiefs furnished information concerning the number of anesthetics per year in their institutions and the frequency of use of pulse oximeters during regional and general anesthesia, as well as in the recovery room, and the frequency of capnography during general anesthesia during the month of January, 1987. To determine the frequency for the entire region, the individual hospital rates were weighted by the number of anesthetics in that hospital.

The survey covered a total of 78,900 anesthetics per year. The frequency of use of pulse oximeters was 76% during general anesthesia, 71% for regional anesthesia, and I 8% during the recovery room period respectively. The frequency of use of capnography during general anesthesia was 60%.

The chiefs were also asked to predict what the frequency of such monitoring would he in their institutions in January, 1988. The rates for the

greater Hartford area were estimated under the assumption of no change in individual hospital case loads. The predicted frequency of the use of pulse oximeters next year is 97%, 87%, and 43% during general anesthesia, regional anesthesia, and the recovery room respectively. The predicted frequency for the use of capnography during general anesthesia is 86%.

We conclude that non-invasive monitoring of oxygenation and the adequacy of ventilation has become the standard of practice in the Hartford, Connecticut region. It appears that it is practical for this type of change in practice standards to occur in as little as two years when there is a consensus among the involved chiefs of anesthesia departments.

Dr. Epstein is Professor and Chairman, Department of Anesthesiology University of Connecticut Health Center and a member of the APSF Newsletter Editorial Board.