Understanding Clinical Alarm Safety

Lukasewicz, Carol L; Mattox, Elizabeth Andersson

doi:10.4037/ccn2015113

Cited by 16 publications

(12 citation statements)

References 35 publications

(52 reference statements)

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“…The alarms needed to be specific as well as sensitive to avoid disturbing patients, bringing them into the hospital unnecessarily, or increasing the risk of alarm fatigue among the nursing team [ 27 ]. There is a significant relationship between alarm exposure and response time [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis

Walter¹,

Schwab²,

Wilkes³

et al. 2023

J Med Internet Res

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Background Virtual care (VC) and remote patient monitoring programs were deployed widely during the COVID-19 pandemic. Deployments were heterogeneous and evolved as the pandemic progressed, complicating subsequent attempts to quantify their impact. The unique arrangement of the US Military Health System (MHS) enabled direct comparison between facilities that did and did not implement a standardized VC program. The VC program enrolled patients symptomatic for COVID-19 or at risk for severe disease. Patients’ vital signs were continuously monitored at home with a wearable device (Current Health). A central team monitored vital signs and conducted daily or twice-daily reviews (the nurse-to-patient ratio was 1:30). Objective Our goal was to describe the operational model of a VC program for COVID-19, evaluate its financial impact, and detail its clinical outcomes. Methods This was a retrospective difference-in-differences (DiD) evaluation that compared 8 military treatment facilities (MTFs) with and 39 MTFs without a VC program. Tricare Prime beneficiaries diagnosed with COVID-19 (Medicare Severity Diagnosis Related Group 177 or International Classification of Diseases–10 codes U07.1/07.2) who were eligible for care within the MHS and aged 21 years and or older between December 2020 and December 2021 were included. Primary outcomes were length of stay and associated cost savings; secondary outcomes were escalation to physical care from home, 30-day readmissions after VC discharge, adherence to the wearable, and alarms per patient-day. Results A total of 1838 patients with COVID-19 were admitted to an MTF with a VC program of 3988 admitted to the MHS. Of these patients, 237 (13%) were enrolled in the VC program. The DiD analysis indicated that centers with the program had a 12% lower length of stay averaged across all COVID-19 patients, saving US $2047 per patient. The total cost of equipping, establishing, and staffing the VC program was estimated at US $3816 per day. Total net savings were estimated at US $2.3 million in the first year of the program across the MHS. The wearables were activated by 231 patients (97.5%) and were monitored through the Current Health platform for a total of 3474 (median 7.9, range 3.2-16.5) days. Wearable adherence was 85% (IQR 63%-94%). Patients triggered a median of 1.6 (IQR 0.7-5.2) vital sign alarms per patient per day; 203 (85.7%) were monitored at home and then directly discharged from VC; 27 (11.4%) were escalated to a physical hospital bed as part of their initial admission. There were no increases in 30-day readmissions or emergency department visits. Conclusions Monitored patients were adherent to the wearable device and triggered a manageable number of alarms/day for the monitoring–team-to-patient ratio. Despite only enrolling 13% of COVID-19 patients at centers where it was available, the program offered substantial savings averaged across all patients in those centers without adversely affecting clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis

Walter¹,

Schwab²,

Wilkes³

et al. 2023

J Med Internet Res

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“…Others have noted variation in alarm terminology across studies. 9,31,33 We explored variation not only in the terms themselves Waveform that was obviously artifact produced by movement/procedure Alarm that does not correctly identify patient's condition Technical monitoring device failure alarms and accurate alarms in response to physiological changes that resolved before medical intervention necessary Artifactual Alarm that was inappropriate given input data value Alarm that led to "no action" Technical artifact alarm or an unimportant alarm less than 15 seconds long Alarm not followed by diagnostic or therapeutic decision Care provider did not enter the room in response to alarm/was not present during alarm Alarm that was appropriate given the input data but patient's condition had not changed in a way that required additional medical attention Alarm that was induced by staff manipulation of patient but not judged to be clinically important Alarm longer than 15 seconds but nurse took no other action except briefly checking monitoring system and silencing alarm Alarm that does not lead to (or should not have led to) intervention or bedside consultation, including those caused by motion artifact a Terms are directly quoted from studies. Definitions were paraphrased as little as possible from the studies to shorten their length but maintain the original meaning.…”

Section: Discussionmentioning

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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“…Tüm sağlık profesyonellerinin farkındalığını artırmak ve ortak noktada buluşmak amacı ile "alarm yorgunluğu", "boş/yanlış alarm", "gerçek alarm" gibi tanımların doğru kullanımı önerilmektedir. Alarm sistemleri ile ilgili sıklıkla kullanılan kavram ve tanımlar Tablo 1'de listelenmiştir (9,(18)(19)(20)(21) .…”

Section: Alarm Sistemleri Ile Ilgili Kavram Ve Tanımlarunclassified

Alarm Management In Intensive Care Units

Ergezen¹,

Kol²,

Ramazanoğlu³

2020

JAREN

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Sağlık hizmetlerinde kullanılan alarm sistemleri, hastada meydana gelebilecek olası sorunlar ve tehlikeli durumlarda sesli ve ışıklı yöntemler ile uyarı veren mekanizmalardır. Alarm sistemleri yoğun bakım ünitelerinde, hastanın durumundaki ani değişimleri belirlemek ve uygun müdahaleleri gerçekleştirmek amacıyla kullanılmaktadır. Alarm sistemleri, hasta güvenliği amacı ile sıklıkla kullanılmasına rağmen, bilgi ve yönetim eksikliğine bağlı sorunları da beraberinde getirmektedir. Bu makalede, alarm sistemleri ile ilgili kavramlar/tanımlar, alarm sistemleri ve hasta güvenliği ilişkisi, alarm yönetimi ile ilgili uygulamalar tartışılmıştır.

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Understanding Clinical Alarm Safety

Cited by 16 publications

References 35 publications

Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis

Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis

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

Alarm Management In Intensive Care Units

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