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Respiratory education and training issues
P87 Evidence-based emergency oxygen guidelines are not being followed in the emergency department
  1. S M Wallace1,
  2. L E Doy1,
  3. E N Kedgley1,
  4. W M Ricketts2
  1. 1Barts and The London School of Medicine and Dentistry, London, UK
  2. 2Homerton University Hospital NHS Foundation Trust, London, UK

Abstract

Introduction and objectives The first Emergency Oxygen Guidelines were published by the BTS in October 20081 and were endorsed by 21 professional bodies, including the College of Emergency Medicine. The 2009 BTS audit2 showed improvement in the use of target saturations in the inpatient setting. We are concerned that uptake has been less impressive in the emergency department (ED).

Methods A retrospective cohort study was performed in a London Hospital of patients aged 16–70 attending the ED. Three time periods were chosen; immediately prior to and after guideline publication (1/7/08–30/9/08 and 1/11/08–31/1/09, respectively) and 18 months after publication (1/4/10–30/6/10). Oxygen use was reviewed for all patients attending the ED with acute coronary syndromes (ACS), stroke, transient ischaemic attack (TIA) or with a known diagnosis of COPD. Patients requiring emergency intubation or on home long-term oxygen therapy (LTOT) were excluded. Patients with known COPD with a diagnosis of ACS/stroke/TIA on that attendance were included in ACS/stroke/TIA category to avoid double counting.

Results A total of 253 individual attendances were reviewed. Initial observations of 58 (23%) patients were performed on oxygen. Abstract P87 Table 1 summarises the use of oxygen in the groups studied.

Conclusions Oxygen is frequently used inappropriately in the ED and there has been no improvement since the guideline publication. Excess use of oxygen is the most common reason for not following the guidelines. This is consistent with historical practice in the ACS/stroke/TIA group, although there appears to be a non-significant (p=0.09) trend towards improvement. One third of COPD patients also inappropriately received excess oxygen. Many patients have their first recorded saturations performed on oxygen which may suggest that guideline adherence within the ambulance service is also sub-optimal. Uptake of the guidelines has not been as good as in the inpatient setting. This may be due to lack of awareness outside the medical specialities. This trust currently has no oxygen champion, and this appointment should improve the situation, as would a programme of education within the ED, which we intend to instigate.

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