Pulse oximetry guides clinical decisions, yet does not uniformly identify hypoxemia. We hypothesized that nursing documentation of notifying providers, facilitated by a standardized flowsheet for documenting communication to providers (physicians, nurse practitioners, and physician assistants), may increase when hypoxemia is present, but undetected by the pulse oximeter, in events termed “occult hypoxemia.” To compare nurse documentation of provider notification in the 4 h preceding cases of occult hypoxemia, normal oxygenation, and evident hypoxemia confirmed by an arterial blood gas reading. We conducted a retrospective study using electronic health record data from patients with COVID-19 at five hospitals in a healthcare system with paired SpO and SaO readings (measurements within 10 min of oxygen saturation levels in arterial blood, SaO, and by pulse oximetry, SpO). We applied multivariate logistic regression to assess if having any nursing documentation of provider notification in the 4 h prior to a paired reading confirming occult hypoxemia was more likely compared to a paired reading confirming normal oxygen status, adjusting for characteristics significantly associated with nursing documentation. We applied conditional logistic regression to assess if having any nursing documentation of provider notification was more likely in the 4-hour window preceding a paired reading compared to the 4-hour window 24 h earlier separately for occult hypoxemia, visible hypoxemia, and normal oxygenation. There were data from 1910 patients hospitalized with COVID-19 who had 44,972 paired readings and an average of 26.5 (34.5) nursing documentation of provider notification events. The mean age was 63.4 (16.2). Almost half (866/1910, 45.3 %) were White, 701 (36.7 %) were Black, and 239 (12.5 %) were Hispanic. Having any nursing documentation of provider notification was 46 % more common in the 4 h before an occult hypoxemia paired reading compared to a normal oxygen status paired reading (OR 1.46, 95 % CI: 1.28–1.67). Comparing the 4 h immediately before the reading to the 4 h one day preceding the paired reading, there was a higher likelihood of having any nursing documentation of provider notification for both evident (OR 1.45, 95 % CI 1.24–1.68) and occult paired readings (OR 1.26, 95 % CI 1.04–1.53). This study finds that nursing documentation of provider notification significantly increases prior to confirmed occult hypoxemia, which has potential in proactively identifying occult hypoxemia and other clinical issues. There is potential value to encouraging standardized documentation of nurse concern, including communication to providers, to facilitate its inclusion in clinical decision-making.

中文翻译：

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护士使用标准化流程图来记录与高级提供者的沟通是否提供了检测脉搏血氧饱和度故障的机制？电子健康记录数据的回顾性研究

脉搏血氧测定法指导临床决策，但不能统一识别低氧血症。我们假设，当存在低氧血症但脉搏血氧计未检测到时，在称为“隐匿性低氧血症”的事件中，通过用于记录与提供者（医生、执业护士和医师助理）沟通的标准化流程促进的通知提供者的护理记录可能会增加”。比较护士记录的 4 小时前隐匿性低氧血症、正常氧合和经动脉血气读数确认的明显低氧血症病例中提供者通知的情况。我们使用医疗保健系统中五家医院的 COVID-19 患者的电子健康记录数据进行了一项回顾性研究，并配有配对 SpO 和 SaO 读数（10 分钟内测量动脉血氧饱和度、SaO 以及脉搏血氧饱和度、SpO ）。我们应用多变量逻辑回归来评估，与确认正常氧状态的配对读数相比，在确认隐匿性低氧血症的配对读数之前 4 小时内是否有提供者通知的任何护理记录更有可能，并根据与护理记录显着相关的特征进行调整。我们应用条件逻辑回归来评估在配对读数之前的 4 小时窗口中是否更有可能拥有提供者通知的任何护理文件，而对于隐匿性低氧血症、明显低氧血症和正常氧合，与 24 小时前的 4 小时窗口相比是否更有可能。数据来自 1910 名因 COVID-19 住院的患者，他们有 44,972 个配对读数，平均有 26.5 (34.5) 份提供者通知事件的护理文档。平均年龄为 63.4 岁 (16.2 岁)。几乎一半（866/1910，45.3%）是白人，701 人（36.7%）是黑人，239 人（12.5%）是西班牙裔。与正常氧状态配对读数相比，在隐匿性低氧血症配对读数之前 4 小时内，拥有提供者通知的任何护理文件的情况要常见 46%（OR 1.46，95% CI：1.28–1.67）。将读数前 4 小时与配对读数前一天 4 小时进行比较，对于明显（OR 1.45，95 % CI 1.24–1.68）和隐匿配对读数，拥有提供者通知的任何护理文件的可能性更高（OR 1.26，95% CI 1.04–1.53）。这项研究发现，在确认隐匿性低氧血症之前，提供者通知的护理记录显着增加，这有可能主动识别隐匿性低氧血症和其他临床问题。鼓励护士关注的标准化记录（包括与提供者的沟通）具有潜在价值，以促进其纳入临床决策。