OXYGEN USAGE IN EMERGENCY DEPARTMENT: IS IT OVERUSED? Harshdeep Acharya1, Jivansha Dua1, KPP Abhilash2, Satish Kumar3, Bijesh4 1. MBBS Student (III year), Christian Medical College, Vellore 2. Associate Professor and Head, Accident and Emergency Department, Christian Medical College, Vellore 3. Social Worker, Accident and Emergency Department, Christian Medical College, Vellore 4. Statistician, Department of Biostatistics, Christian Medical College, Vellore Though oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs. This leads to over utilization of this very expensive resource. So we decided to do this study to analyse the pattern of oxygen use in the Emergency Department (ED), and to determine the common reasons for initiation of oxygen therapy. This was also aimed at determining the additional direct medical expense to the patient, so that it can be prevented. This was a cross sectional observational study done in the Emergency Department (ED) of CMC, Vellore. All patients who were administered oxygen in the ED over a 3 week period in April 2016 were included in the study. Details of oxygen administration and outcome were analysed. Oxygen administered without hypoxia was considered as inappropriate. A direct medical cost analysis was done for the patients who were administered oxygen inappropriately. 15.4% (363/2356) of the patients presenting to the ED were administered oxygen. About a third of them (35.8%) were administered oxygen inappropriately. Majority of the patients (67.6%) were triaged as priority 1 patients. The common reasons for initiation of oxygen therapy were dyspnea (56.7%), low sensorium (14.0%), intubated elsewhere (11.0%), polytrauma (7.2%) and seizures (4.4%). The most common reason for initiation of oxygen therapy is breathlessness. But a large proportion (23.8%) of these patients were administered oxygen with just tachypnea and not hypoxia. Among the patients with low sensorium, 60.7% of the patients did not require oxygen. Among patients with seizures and trauma who were given oxygen, 87.5% and 84.4% of them did not require the oxygen respectively. The mean duration of Oxygen therapy among patients who didn’t require it was 7.3 ± 4.6 hours. Oxygen is charged at ₹ 45 per hour. Adding this to the additional costs of oxygen mask and monitoring charges, it resulted in an increase of an average of ₹ 737 in the treatment cost. This avoidable cost burden to the patient is very significant in this setting. The current plan is to implement proper protocol based on BTS guidelines in the ED and analyse decrease in inappropriate oxygen therapy in the post-protocol phase, which is in progress.
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