Original Articles PULSEOXlMETRY, CAPNOGRAPHY, ANU BLOOD GAS MEASUREMENTS: REDUCING COST AND IMPROVING THE QUALITY OF CARE WITH TECHNOLOGY Michael F. Roizen, MD, Bruce Schreider, MD, PhD, Wayne Austin, MBA, Chris Carter, MD, and Susan Polk, MD Roizen MF, Schreider B, Austin W, Carter C, Polk S. Pulse oxime- try, capnography, and blood gas measurements: reducing cost and improving the quality of care with technology. J Clin Monit 1993;9:237-240 AGSTRACT. Pulse oximetry appears to improve quality of care by the early detection of hypoxia noninvasively. We tested the hypothesis that the widespread use of pulse oximetry over a 5-year period in the operating rooms at our institution had resulted in a reduction in blood gas measurements and in de- partmental operating costs. The total number of blood gas determinations per hour of anesthetic time at our institution decreased by 44%, from 7.64 to 4.26 measurements per 100 operating room hours. The number of capnography units in the operating rooms increased from 8 to 14, the number of pulse oximeters increased from 0 to 22, and oximeter use increased from 0 to 100% for all anesthetics. The total cost to provide oximetry, capnography, and blood gas measurements in 1989-1990 was less than the cost to provide blood gas measurements alone in 1985-1986. The introduction of these technologies was accomplished without an increase in cost: $76,880 in 1985-1986 versus $71,025 in 1989-1990. KEYWORgS. Complications: hypoxemia. Monitoring: oxygen. Measurement techniques: pulse oximetry. From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL. Received Oct 30, 1991, and in revised form Aug 19, 1992. Accepted for publication Aug 24, 1992. Address correspondence to Dr Roizen, Department of Anesthesia and Critical Care, Box 428, University of Chicago, 5841 S Maryland, Chicago, IL 60637. Oxygen saturation and the clinical impression ofcyano- sis were first correlated in 1919 by Stadie [1]. In 1947, Comroe and Botelho [2] demonstrated the poor detec- tion rate of cyanosis and hypoxia by clinicians. They concluded that visual impressions of cyanosis were an unreliable guide for the detection of arterial hypoxia. Arterial hypoxia may result in permanent physical dam- age or the death of a patient. Detection and prevention of hypoxic events during anesthesia therefore can be expected to contribute to improved outcomes. With the advent of pulse oximetry in the early 1980s, anesthesiologists were provided with a noninvasive, ac- curate, continuous, real-time method for monitoring the blood oxygen content of a patient. Many anesthesi- ologists believe that pulse oximetry has resulted in a higher quality of care, and there have been attempts in the literature to demonstrate the validity of this belief [3-6]. We tested the hypothesis that widespread use of pulse oximetry in the operating rooms at our institution had resulted in a reduction of blood gas determinations and a reduction in cost. During this same period, cap- nography was increasingly available in our operating rooms. Because such availability also may have contrib- uted to the decrease in number of blood gas determina- tions, the costs of capnography also were calculated. METHODS With institutional review board approval, we analyzed cost and use for all anesthetics administered at the Uni- Copyright 9 1993 by Little, Brown and Company 237