Intensive care unit alarms—How many do we need?*

Siebig, Sylvia; Kuhls, Silvia; Imhoff, Michael; Gather, Ursula; Schölmerich, Jürgen; Wrede, Christian

doi:10.1097/ccm.0b013e3181cb0888

Cited by 188 publications

(128 citation statements)

References 13 publications

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“…Four of the studies were conducted in pediatric populations 5,[20][21][22] and 7 were conducted in adult populations. [23][24][25][26][27][28][29] One study included both children and adults. 30 Additionally, in 1 study, 5 alarms in both a pediatric general care area and a pediatric ICU were annotated; for this review, we used only pediatric ICU data.…”

Section: Resultsmentioning

confidence: 99%

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Ruppel

Funk

Whittemore

2018

American Journal of Critical Care

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Background Alarm fatigue threatens patient safety by delaying or reducing clinician response to alarms, which can lead to missed critical events. Interventions to reduce alarms without jeopardizing patient safety target either inaccurate or clinically irrelevant alarms, so assessment of alarm accuracy and clinical relevance may enhance the rigor of alarm intervention studies done in clinical units. Objectives To (1) examine approaches used to measure accuracy and/or clinical relevance of physiological monitor alarms in intensive care units and (2) compare the proportions of inaccurate and clinically irrelevant alarms. Methods An integrative review was used to systematically search the literature and synthesize resulting articles. Results Twelve studies explicitly measuring alarm accuracy and/or clinical relevance on a clinical unit were identified. In the most rigorous studies, alarms were annotated retrospectively by obtaining alarm data and parameter waveforms rather than being annotated in real time. More than half of arrhythmia alarms in recent studies were inaccurate. However, contextual data were needed to determine alarms’ clinical relevance. Proportions of clinically irrelevant alarms were high, but definitions of clinically irrelevant alarms often included inaccurate alarms. Conclusions Future studies testing interventions on clinical units should include alarm accuracy and/or clinical relevance as outcome measures. Arrhythmia alarm accuracy should improve with advances in technology. Clinical interventions should focus on reducing clinically irrelevant alarms, with careful consideration of how clinical relevance is defined and measured.

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Section: Resultsmentioning

confidence: 99%

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Ruppel

Funk

Whittemore

2018

American Journal of Critical Care

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“…Both cases compete for alarm fatigue and put patient safety at risk (6,9) . In this sense, the proper programming of alarms to the individual needs of patients has to be immediately incorporated into the routine of nursing.…”

Section: Discussionmentioning

confidence: 99%

“…In this sense, scholars and researchers warn of a phenomenon that incites an even bigger concern: alarm fatigue (6) . Alarm fatigue is defined as the phenomenon that occurs when a very large number of alarms covers the clinically significant ones, enabling alarms of clinical relevance to be disabled, silenced and ignored by the team (7) .…”

Section: Introductionmentioning

confidence: 99%

Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices

et al. 2017

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RESEARCHStimulus-response time to alarms of the intra-aortic balloon pump:safe care practices ABSTRACT Objective: To characterize the sound alarms of the Intra-Aortic Balloon Pump (IABP) during aortic counterpulsation therapy; to measure the stimulus-response time of the team to these; and to discuss the implications of increasing this time for patient safety from the alarm fatigue perspective. Method: This is an observational and descriptive study with quantitative and qualitative approach, case study type, carried out in a Cardiac Surgical Intensive Care Unit. Results: The most audible IABP alarm was the one of high priority increased-reduced diastolic blood pressure. The stimulus-response time was 33.9 seconds on average. Conclusion: Managing the alarms of these equipment is essential to minimize the occurrence of the alarm fatigue phenomenon and to offer a safer assistance to patients who rely on this technology.

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“…Studies have found alerts from monitoring systems in an ICU and emergency department environment to be tremendously frequent and with an extremely high false-positive rate. [17][18][19][20][21] Unsurprisingly, it has been reported that only about 10% of alerts are responded to by the clinical staff. 22 In an attempt to improve alert relevancy and accuracy, newly designed integrated monitoring systems for ICUs use alert algorithms and trend analysis performed on data received from multiple vital signs monitors.…”

Section: Discussionmentioning

confidence: 99%

Early recognition of acutely deteriorating patients in non‐intensive care units: Assessment of an innovative monitoring technology

Zimlichman

Szyper‐Kravitz

Shinar

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Continuous vital sign monitoring has the potential to detect early clinical deterioration. While commonly employed in the intensive care unit (ICU), accurate and noninvasive monitoring technology suitable for floor patients has yet to be used reliably.OBJECTIVE:To establish the accuracy of the Earlysense continuous monitoring system in predicting clinical deterioration.DESIGN:Noninterventional prospective study with retrospective data analysis.SETTING:Two medical wards in 2 academic medical centers.PATIENTS:Patients admitted to a medical ward with a diagnosis of an acute respiratory condition.INTERVENTION:Enrolled patients were monitored for heart rate (HR) and respiration rate (RR) by the Earlysense monitor with the alerts turned off.MEASUREMENTS:Retrospective analysis of vital sign data was performed on a derivation cohort to identify optimal cutoffs for threshold and 24‐hour trend alerts. This was internally validated through correlation with clinical events recognized through chart review.RESULTS:Of 113 patients included in the study, 9 suffered major clinical deterioration. Alerts were found to be infrequent (2.7 and 0.2 alerts per patient‐day for threshold and trend alert, respectively). For the threshold alerts, sensitivity and specificity in predicting deterioration was found to be 82% and 67%, respectively, for HR and 64% and 81%, respectively, for RR. For trend alerts, sensitivity and specificity were 78% and 90% for HR, and 100% and 64% for RR, respectively.CONCLUSIONS:The Earlysense monitor was able to continuously measure RR and HR, providing low alert frequency. The current study provides data supporting the ability of this system to accurately predict patient deterioration. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

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Intensive care unit alarms—How many do we need?*

Cited by 188 publications

References 13 publications

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices

Early recognition of acutely deteriorating patients in non‐intensive care units: Assessment of an innovative monitoring technology

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