Continual vital sign assessment on the general care, medical-surgical floor is expected to provide early indication of patient deterioration and increase the effectiveness of rapid response teams. However, there is concern that continual, multi-parameter vital sign monitoring will produce alarm fatigue. The objective of this study was the development of a methodology to help care teams optimize alarm settings. An on-body wireless monitoring system was used to continually assess heart rate, respiratory rate, SpO2 and noninvasive blood pressure in the general ward of ten hospitals between April 1, 2014 and January 19, 2015. These data, 94,575 h for 3430 patients are contained in a large database, accessible with cloud computing tools. Simulation scenarios assessed the total alarm rate as a function of threshold and annunciation delay (s). The total alarm rate of ten alarms/patient/day predicted from the cloud-hosted database was the same as the total alarm rate for a 10 day evaluation (1550 h for 36 patients) in an independent hospital. Plots of vital sign distributions in the cloud-hosted database were similar to other large databases published by different authors. The cloud-hosted database can be used to run simulations for various alarm thresholds and annunciation delays to predict the total alarm burden experienced by nursing staff. This methodology might, in the future, be used to help reduce alarm fatigue without sacrificing the ability to continually monitor all vital signs.Electronic supplementary materialThe online version of this article (doi:10.1007/s10877-015-9790-8) contains supplementary material, which is available to authorized users.

This article is intended to guide stakeholders in developing sustainable solutions and to serve as a foundation for discussions with hospital executives, healthcare technology managers, patient safety officers, and risk managers. The framework is not intended to be prescriptive but rather a guide for continuous improvement efforts to reduce nonactionable alarms of all types originating from medical devices. High rates of false and nonactionable alarms have made it difficult for clinicians to effectively redirect attention to truly hazardous events.

An ability to rapidly convert data from multiple different sources into actionable information is embodied in a concept called Real-time Health Systems (RTHS). The foundational component of RTHS is a modern Clinical Communication and Collaboration (CC&C) Platform, which translates organizational knowledge into action. Effective communication is the key. A CC&C Platform that can receive data from multiple hospital systems, analyze the data, arbitrate any resulting actions and determine the relative priorities to distribute work to the right person or teams–can lead to improved operational efficiencies and better patient outcomes.