Table 4 Theme 2: Impact on perioperative patient monitoring

Preoperative Assessment

Pulse oximetry

1) provides comprehensive baseline of oxygen saturation and pulse

2) prompts assessment of underlying conditions

Lack of pulse oximetry availability on the wards limits ability to perform preoperative assessment

“In this COVID era actually, we realize [the patient] had bilateral desaturation … he was COVID positive. But everything else was okay until we connected the pulse oximeter.”

Intraoperative Monitoring

Pulse oximetry allows for oxygen saturation and heart rate monitoring during surgery

Lifebox training

1) incorporates use of Surgical Safety Checklist

2) reiterates key anesthesia principles e.g. treatment of hypoxia, laryngospasm etc.

Lack of pulse oximetry in all operating rooms delays cases

“I had a case that it was just a cesarean section. … I didn’t have the pulse oximeter, I looked around. … I wouldn’t start a case without a pulse oximeter.”

Postoperative Assessment

Pulse oximetry

1) allows objective assessment by non-anesthesia providers

2) improves communication between the PACU/ward team and anesthesia team

3) Allows recognition and treatment of hypoxia in the immediate postoperative period

Lack of pulse oximetry outside of the operating room delays transfer to recovery area

Some recovery areas have no resources to monitor patients and/or nurses do not have training

Some hospitals do not have designated recovery areas and patients are transferred from the operating room to wards that do not have monitoring capabilities

“being trained, going to school doing anesthesia … makes it difficult for me to just do short cuts and pretend all is well… because of lack of a pulse oximeter in my recovery, I’m forced to keep my patients on the table until they recover.”

“Before I had the pulse oximeter, I wasn’t so confident leaving my patients in the post-operative ward… but now I can confidently do that because I can see the readings.”

ICU and Ward Care

When monitors are not available in wards, a portable pulse oximeter

1) allows anesthesia to assess saturation in the ICU

2) facilitates work up of respiratory conditions

Lack of pulse oximetry on the wards requires anesthesia providers to borrow operating room pulse oximeters when evaluating critically ill patients

Nurses on all wards are not familiar with the pulse oximeter

“when we’re going out there to see patients, in ICU … I have to literally go back to theatre and get the one I use … For a short time and take it back.”

“the patient can be lying on the table, on the bed without realizing that the saturation is going down. If those nurses - even other people in the theatre - can have that knowledge they will be quick to act.”