The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study

Abstract

ObjectivesTo determine (1) the proportion and number of clinically relevant alarms based on the type of monitoring device; (2) whether patient clinical severity, based on the sequential organ failure assessment (SOFA) score, affects the proportion of clinically relevant alarms and to suggest; (3) methods for reducing clinically irrelevant alarms in an intensive care unit (ICU).DesignA prospective, observational clinical study.SettingA medical ICU at the University of Tokyo Hospital in Tokyo, Japan.ParticipantsAll patients who were admitted directly to the ICU, aged ≥18 years, and not refused active treatment were registered between January and February 2012.MethodsThe alarms, alarm settings, alarm messages, waveforms and video recordings were acquired in real time and saved continuously. All alarms were annotated with respect to technical and clinical validity.Results18 ICU patients were monitored. During 2697 patient-monitored hours, 11 591 alarms were annotated. Only 740 (6.4%) alarms were considered to be clinically relevant. The monitoring devices that triggered alarms the most often were the direct measurement of arterial pressure (33.5%), oxygen saturation (24.2%), and electrocardiogram (22.9%). The numbers of relevant alarms were 12.4% (direct measurement of arterial pressure), 2.4% (oxygen saturation) and 5.3% (electrocardiogram). Positive correlations were established between patient clinical severities and the proportion of relevant alarms. The total number of irrelevant alarms could be reduced by 21.4% by evaluating their technical relevance.ConclusionsWe demonstrated that (1) the types of devices that alarm the most frequently were direct measurements of arterial pressure, oxygen saturation and ECG, and most of those alarms were not clinically relevant; (2) the proportion of clinically relevant alarms decreased as the patients’ status improved and (3) the irrelevance alarms can be considerably reduced by evaluating their technical relevance.

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

“…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.…”

“…Most studies originated in the United States, 5,[20][21][22][23]26,29 with 1 study each from England, 30 Finland, 28 France, 27 Germany, 25 and Japan. 24 All studies used observational/descriptive designs; no intervention studies met inclusion criteria. Studies are presented in Table 1 in chronological order by publication year.…”

“…In other studies, actual digitized waveforms were stored for review. 20,23,24 By evaluating waveforms to identify artifact during an alarm condition, researchers assessed alarms for accuracy. Some researchers also used video recordings in patients' rooms to annotate alarms' clinical relevance by assessing patient status and interventions at the time of the alarm.…”

“…30 In 2010, researchers began publishing on extracted and stored electronic alarm data and/or physiological parameter waveforms and retrospective alarm annotation. 5,20,[23][24][25] In 1 study, 32 researchers obtained waveforms from video recordings of monitor screens. Researchers used alarm data captured from the monitoring system to determine the time of alarm and then reviewed the corresponding video recording.…”

Nurses' Attitudes Related To Alarm Fatigue in Critical Care Units: A Systematic Review

“…When the healthcare provider is exposed to a huge number of alarms, many of which are false alarms, within working time, they will suffer from sensory overload which leads to ignoring or delaying in response to the alarm ] 18[ . This can cause harm to the patient indirectly, and place patient at risk of severe injury or death ]17[.…”