Association of Oxygen Saturation on Home Pulse Oximetry With Telephone Triage Decision

Background

Given limited tools for objective assessment during telephone triage, home pulse oximeters may augment clinical decision-making in patients with respiratory conditions. However, there are well-documented concerns about clinically significant, race-discrepant pulse oximetry error.

Research Question

Is home pulse oximetry incorporated into telephone triage decision-making and is it associated with triage disposition?

Study Design and Methods

In this retrospective study, we reviewed electronic medical record documentation regarding telephone calls to the pulmonary clinic triage line at a university-affiliated tertiary care center. All adults who called the triage line with an acute complaint between May 1, 2023, and October 31, 2023, were included. We tested the association between reported abnormal oxygen saturation and triage decision.

Results

A total of 118 telephone triage notes were reviewed. Median patient age was 50 years (interquartile range, 34-62), with 85 calls (72%) from White patients and 24 calls (20%) from Black patients. Of the calls, 70% (n = 83) were for respiratory symptoms. Pulse oximeter use was reported in 29 notes. No notes documented consideration of factors that might influence pulse oximeter accuracy. Among calls for respiratory symptoms, 24 (29%) discussed home pulse oximetry. Twenty-one calls (18%) were referred to the emergency department or hospital, and 12 (10%) were referred for an urgent visit. In multivariable analysis, patients with respiratory symptoms and peripheral oxygen saturation < 90% had 22.3 times the odds (95% CI, 1.9-258.9; P = .01) of being triaged to in-person care.

Interpretation

In this study, providers documented home pulse oximetry readings in 1 in 3 patients calling the pulmonary triage line with respiratory symptoms. Patients with abnormal oxygen saturation were more likely to be triaged to in-person evaluation. Given the current state of widely available, variably accurate, and racially biased pulse oximeters, there is an opportunity for standardization of how triaging providers assess home pulse oximetry data and counsel patients on their limitations.