PICU Alarm Fatigue

Using advanced analytics, the UR Health Lab has created tools for a more comprehensive understanding of the alarms in the units. These alarm reduction tools aim to improve patient care and reduce alarm fatigue in Pediatric ICUs.

URMC’s Pediatric ICUs generate about eight alarms for each patient every hour, and evidence suggests that 80-99% of these alarms are nonactionable and unnecessary. UR Health Lab has partnered with Pediatric Cardiac Intensivist, Dr. Heather Reyes, to gather data on these alarms. The goal is to identify nonactionable alarms, creating solutions to bring awareness to alarm fatigue and use analytics to reduce the alarms.

Alarm fatigue is dangerous and disruptive to patient care:

• High numbers of nonactionable alarms are dangerous to patient care and interruptive to workflow. Studies demonstrating that each task interruption increases the likelihood of a mistake after resumption of that activity by 25%.
• Alarms impact patient rest. There is an increasing body of data which suggests that the quality of sleep in an ICU setting may prevent delirium, which has been associated with increased mortality and a greater than two times longer length of stay.
• There is a strong correlation between reduction of audible alarms and improved nursing and patient satisfaction scores. According to Press Ganey, Boston Medical Center was able to increase its percentile ranks from 12-39 points in five key domain areas by simply reducing the number of sounding alarms in patient-clinical areas.

While the alarms can be helpful to patient care, the ever-growing number of parameters these alarms are linked to have become overwhelming. The importance of clinically relevant alarms has been recognized as a critical patient safety issue by multiple oversight institutes. This product arms those at the bedside with the power to identify nonactionable alarms and the data to drive clinical and management solutions. (Dr. Heather Reyes)

The UR Health Lab team has brought together 4 different alarm data streams in our data warehouse:

1. Alarm context including source, duration, and value.
2. EHR data including demographic, patient stay, diagnosis, and flowsheet information.
3. Bedside vital sign monitor and ventilator data, obtained in partnership with Real-Time Integration (ISD). This data provides further context on patient status at the time of an alarm, and how the patient responded to subsequent interventions.
4. In a novel attempt to capture the most ambiguous data surrounding alarm fatigue, the actionable nature of an alarm, the UR Health Lab has armed domain experts (bedside nurses and clinicians) with the ability to label alarms. UR Health Lab created 3D printed buttons for each ICU room, with three buttons to empower those at the bedside to label alarms as nonactionable, actionable, or critical as part of their typical workflow.

The UR Health Lab has created a visualization tool for use at bedside, providing context for alarms at a patient and unit level. This tool will allow clinicians to understand patterns in alarm activity and arm them with the data to make informed decisions for reducing alarm fatigue, improving patient care and staff burnout.