Understanding the “alarm problem” associated with continuous physiologic monitoring of general care patients

McGrath, Susan; Perreard, Irina; McGovern, Krystal M; Blike, George T.

doi:10.1016/j.resplu.2022.100295

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…[57][58][59] A recent analysis of continuous Spo 2 data from patients in general care units was undertaken to understand alarm behavior under different configurations of alarm activation thresholds, annunciation delays, and notification modes. 60 Common default condition-specific settings are used to detect any abnormality (Spo 2 <90%, pulse rate <60 or >120 beats per minute [bpm]). Such settings with a 5:1 patient-to-nurse ratio would expose a nurse to 1971 audible alarms per 12-hour shift with traditional broadcast notification.…”

Section: False Alarms With Continuous Monitoring Are Manageable and M...mentioning

confidence: 99%

“…Although patients are more likely to be monitored postoperatively if they are given opioids, failure to configure alarms creates a major alarm-fatigue burden. 60 Using default alarm settings with the alarm set on high and leaving the room door open neither builds confidence nor improves safety. Thus, human factors and usability are important considerations in minimizing technological burden.…”

Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 99%

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Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Blike,

McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual’s risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a “surveillance model” can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

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Section: False Alarms With Continuous Monitoring Are Manageable and M...mentioning

confidence: 99%

Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 99%

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Blike,

McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

Self Cite

View full text Add to dashboard Cite

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“…A clinician must first determine whether an arrhythmia alarm is caused by sinus tachycardia, ventricular fibrillation, or artifact. Each of these conditions requires an action that depends on its specific context and may not easily be resolved by following a linear checklist [18 ▪▪ ]. Like air traffic controllers, clinicians should undergo regular training on how to use automated medical devices (such as anesthesia machines and physiologic monitors).…”

Section: Automation and Alarmsmentioning

confidence: 99%

In control or along for the ride? Lessons for anesthesiologists from air traffic control

Ruskin

Dutton

Ruskin

2023

Current Opinion in Anaesthesiology

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Purpose of review Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways. Recent findings The increasing complexity of the healthcare environment suggests that the complete elimination of human error is not possible. Complex clinical situations predispose to errors that are the result of high workload, decision making under stress, and poor team coordination. The theory behind complex adaptive systems differs from medicine's traditional approach to safety and highlights the importance of an institutional safety culture that encourages flexibility, adaptability, reporting and learning from errors. Instead of focusing on standardization and strict adherence to procedures, clinicians can improve safety by recognizing that unpredictable changes routinely occur in the work environment and learning how resilience can prevent adverse events. Summary A better understanding of automation, complexity, and resilience in a changing environment are essential steps toward the safe practice of anesthesia.

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Understanding the “alarm problem” associated with continuous physiologic monitoring of general care patients

Cited by 2 publications

References 23 publications

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

In control or along for the ride? Lessons for anesthesiologists from air traffic control

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