Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

Abstract

Background10The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers.MethodsIn a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level.ResultsAt baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014–2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures.ConclusionWe successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study

“…In line with previous publications, respondents reported that the high rate of false alarms interrupted patient care and demanded a hospital SOP for alarm management [ 21 ]. In several studies, implementation of such an alarm management SOP reduced the alarm rate significantly [ 21 , 22 ]. Further temporal analysis of the alarm frequencies per sensor as previously described [ 23 ] may find causes for the high rate of false alarms.…”

“…Our survey results show that ICU staff members are open to learning more about technology and are even willing to support product development in some cases. Thus, a clinical data scientist with formal medical training could be part of the ICU team as well as the product development team alongside engineers from a medical manufacturer [ 22 , 37 ]. This transdisciplinary approach should be piloted in further studies, to assess the effects on mutual exchange and innovation potential.…”

Reducing medical device alarms by an order of magnitude: A human factors approach

“…These smarter algorithms are currently being created through consultation with clinical experts. 40 However, in the future, such algorithms could also include approaches using machine learning and artificial intelligence techniques, making use of real patient data in offline big datasets and then applied to live patient devices, but only after appropriate safety testing. 20,25,27 When all available parameters from all available devices are combined into a system of comprehensive alarms, these can be better prioritised within the work process of the healthcare provider, resulting in substantially fewer but more meaningful alarms (see Figures 2 and 3).…”

“…These smarter algorithms are currently being created through consultation with clinical experts. 40 However, in the future, such algorithms could also include approaches using machine learning and artificial intelligence techniques, making use of real patient data in offline big datasets and then applied to live patient devices, but only after appropriate safety testing. 20,25,27…”

Sounds good: the bright future of clinical alarm management initiatives

“…In this issue of BMJ Quality and Safety, Pater et al 12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit. The primary project goal was to reduce alarm notifications from continuous bedside monitoring.…”