Physiologic monitoring alarm load on medical/surgical floors of a community hospital.

UNLABELLED: It has been known to the public that high frequency of false and/or unnecessary alarms from patient monitoring devices causes "alarm fatigue" in critical care. But little is known about the impact to care on the less acute patients located outside the critical care areas, such as the traditional medical/surgical (med/surg) floor.

METHODS: As part of a larger population management study, we initiated continuous physiological monitoring to 79 beds of floor patients in a community hospital. In order to qualify the patient monitoring alarm load for subacute medical and surgical floor patients, we assessed alarm data from April 2009 to January 2010. A standard critical care monitoring system (Philips IntelliVue MP-5 and Telemetry) was installed and set to the default alarm limits. All waveform data available for the patient (typically ECG, RESP, PPG at 125hz 8 bit), all alarm conditions declared by the monitoring system, and 1 minute parameter trend data were saved to disk every 8 hours for all patients. A monitoring care protocol was created to determine whether the patient was monitored via the hardwired bedside or wirelessly via telemetry. Alarms were not announced on the care unit but instead notifications were the responsibility of remote telehealth center personnel. We retrospectively evaluated the frequency of alarms over specific physiologic thresholds (n= 4104 patients) and conducted adjudication of all alarms based on a smaller sampling (n=30 patients).

RESULTS: For all patients, the average hours of monitoring per patient were 16.5 hours with a standard deviation (s) of 8.3 hours and a median of 22 hours. The average number of alarms (all severities) per patient was 69.7 (s =90.3, median =28) alarms. When this is adjusted to the duration of monitoring, the average per patient, per day rate was 95.6 (s =124.2, median =34.2) alarms. The adjudicated sample (n=30 patients) resulted in 34% of critical alarms (lethal arrhythmias, extreme high or low heart rate [HR], extreme desaturation, apnea) being true and 63% of the high priority alarms (high or low HR, high or low RR, Low SpO(2), pause, Missed Beat, Pair PVCs, Pacer Not Pace, Non Sustain VT, Irregular HR, Multiform) being true. Analysis of alarm history resulted in the ability to reduce the HR alarm load by more than 50% with a simple limit adjustment of high HR from 120 to 130 bpm and a 36% or 65% reduction in SpO(2) alarm load by reducing the SpO(2) limit from 90% to 85% or 80% respectively.

CONCLUSION: 1) Standard critical care alarm limits appear be too sensitive for subacute care areas of the hospital. 2) For most patients these alarm limits do not create a significant alarm load; however, for a small number of patients they cause a significant alarm load. 3) Alarm loads can be controlled with alarm limit settings appropriate to the population. 4) Current technology for HR and SpO(2) appear suitable for continuous monitoring of this population.