Does the architectural layout of a NICU affect alarm pressure? A comparative clinical audit of a single-family room and an open bay area NICU using a retrospective study design

Abstract

ObjectivesTo determine differences in alarm pressure between two otherwise comparable neonatal intensive care units (NICUs) differing in architectural layout—one of a single-family room (SFR) design and the other of an open bay area (OBA) design.DesignRetrospective audit of more than 2000 patient days from each NICU cataloguing the differences in the number and duration of alarms for critical and alerting alarms, as well as the interaction of clinicians with the patient monitor.SettingTwo level 3 NICUs.ResultsA total of more than 150 000 critical and 1.2 million alerting alarms were acquired from the two NICUs. The number of audible alarms and the associated noise pollution varied considerably with the OBA NICU generating 44% more alarms per infant per day even though the SFR NICU generated 2.5 as many critical desaturation alarms per infant per day.ConclusionDifferences in the architectural layout of NICUs and the consequent differences in delays, thresholds and distribution systems for alarms are associated with differences in alarm pressure.

Optimisation of clinical workflow and monitor settings safely reduces alarms in the NICU

“… Protocols for application, positioning and replacement of electrodes and sensors and protocol for the patients' admission and discharge from system were standardised. Delay time for saturation‐related alarms was increased from 10 to 20 seconds based on the findings from 7,23,24 . Averaging time was decreased from 10 to 4 seconds as suggested in 21,25 . An additional red ‘smart alarm’ was introduced to indicate yellow alarms lasting for more than 5 minutes.…”

“…More details about the organisation of the NICU and the equipment provided in each room can also be found in other works. [19][20][21] In the unit, patient monitors are connected to a network, displaying alarms both on the central monitor and other bedside monitors.…”

“…7,23,24 Averaging time was decreased from 10 to 4 seconds as suggested in. 21,25 An additional red 'smart alarm' was introduced to indicate yellow alarms lasting for more than 5 minutes. All modification to alarms are summarised in Table 2.…”

“…In one of our previous studies, the alarm burden increased from 42 to 67 red alarms per patient day when alarms due to ventilation were considered. 21 Future studies could more elaborately investigate nurses' responses by analysing escalation of alarms and the actual time needed for responding to different alarms.…”

Evaluación de la arquitectura hospitalaria: unidad de neonatología

“…El análisis de los datos recogidos se realizó por la misma autora en noviembre de 2018 y fue supervisado por los dos coautores. Tras analizar literatura científica sobre el diseño de las unidades de neonatología, se observa que gran parte de los estudios se centran en el efecto de la iluminación y el sonido sobre el desarrollo del neonato (28,29,30,31,32,33), la comparación entre salas múltiples y habitaciones individuales (34,35,36,37,38,39) o el diseño de la habitación individual (40,41,42,43). Sin embargo, el análisis de unidades en su conjunto, las relaciones entre sus locales e incluso la enumeración y características de los locales necesarios, se suele abordar desde las guías institucionales de cada país (44,45).…”