The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study
- Ryota Inokuchi1,
- Hajime Sato2,
- Yuko Nanjo1,
- Masahiro Echigo3,
- Aoi Tanaka1,
- Takeshi Ishii1,
- Takehiro Matsubara1,
- Kent Doi1,
- Masataka Gunshin1,
- Takahiro Hiruma1,
- Kensuke Nakamura1,
- Kazuaki Shinohara4,
- Yoichi Kitsuta1,
- Susumu Nakajima1,
- Mitsuo Umezu3,
- Naoki Yahagi1
- 1Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- 2Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Saitama, Japan
- 3Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Shinjuku-ku, Tokyo, Japan
- 4Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan
- Correspondence to Dr Hajime Sato;
- Received 7 June 2013
- Revised 24 July 2013
- Accepted 30 July 2013
- Published 9 September 2013
Objectives To 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).
Design A prospective, observational clinical study.
Setting A medical ICU at the University of Tokyo Hospital in Tokyo, Japan.
Participants All patients who were admitted directly to the ICU, aged ≥18 years, and not refused active treatment were registered between January and February 2012.
Methods The 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.
Results 18 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.
Conclusions We 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.
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