Thomas Nahass, MD
Fellow
Memorial Sloan Kettering Cancer Center
New York, NY
Disclosure information not submitted.
Yekaterina Tayban, ACNP-BC, FCCP
APP Manager
Memorial Sloan Kettering Cancer Center, United States
Disclosure information not submitted.
Sanjay Chawla, BS, MD, FCCM
Associate Attending
Memorial Sloan Kettering - Anesthesia & CCM, United States
Disclosure information not submitted.
Title: EHR Integration of the ROX and ROX-HR Scores to Monitor Respiratory Status in COVID-19 Patients
Introduction/Hypothesis: The ROX indices offer clinicians an objective assessment of respiratory status while on high flow nasal cannula (HFNC). In the ongoing COVID pandemic these scores can provide a specific pathway for alerting teams of impending respiratory decline. The scores use SpO2, FiO2, respiratory and heart rates in a ratio that are trended to identify deterioration. Leveraging data within the electronic health record (EHR) can alleviate clinician workload and guarantee uniformity in measurements and timing. We describe the IT implementation of auto-calculation of ROX indices for patients on HFNC.
Methods: Critical care physicians & advanced practice providers, hospitalists, step-down nursing staff, and respiratory therapists were identified as key stakeholders who would care for COIVD patients and were given a brief in-service of the indices. Accuracy of key elements were reviewed with staff to ensure proper timing and measurement. Working with the EHR IT team, calculated fields for the ROX indices were developed and incorporated into the vital sign flowsheet for all COVID patients who were started on HFNC. Implementation data was collected from 2/16 - 7/28/21.
Results: Upon initiation of HFNC, ROX indices scores are automatically calculated and recalculated each time vital signs are taken every two hours. If the ROX-HR is below 6.88 or the ROX is below 4.88, a critical downward arrow appears next to the numerical value. During the implementation period 12 COVID patients were placed on HFNC, 588 of both ROX indices were calculated and of these there were 262 ROX-HR and 89 ROX scores deemed as critical. After reaching critical values, clinicians are able to activate a pathway to escalate the level of care.
Conclusions: Implementation of the ROX indices into the EHR was feasible and can assist clinicians in detecting patients at higher risk of respiratory failure. During the COVID pandemic, monitoring these scores from the EHR can objectively assess respiratory status and possibly improve patient safety by earlier recognition of respiratory decompensation and expedite escalation of care. Further studies are needed to review the outcomes of patients monitored through these scores for morbidity and mortality.