The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units

A pilot study

Ryota Inokuchi, Hajime Sato, Yuko Nanjo, Masahiro Echigo, Aoi Tanaka, Takeshi Ishii, Takehiro Matsubara, Kent Doi, Masataka Gunshin, Takahiro Hiruma, Kensuke Nakamura, Kazuaki Shinohara, Yoichi Kitsuta, Susumu Nakajima, Mitsuo Umezu, Naoki Yahagi

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Article numbere003354
    JournalBMJ Open
    Volume3
    Issue number9
    DOIs
    Publication statusPublished - 2013

    Fingerprint

    Intensive Care Units
    Arterial Pressure
    Electrocardiography
    Tokyo
    Oxygen
    Equipment and Supplies
    Organ Dysfunction Scores
    Video Recording
    Observational Studies
    Japan

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units : A pilot study. / Inokuchi, Ryota; Sato, Hajime; Nanjo, Yuko; Echigo, Masahiro; Tanaka, Aoi; Ishii, Takeshi; Matsubara, Takehiro; Doi, Kent; Gunshin, Masataka; Hiruma, Takahiro; Nakamura, Kensuke; Shinohara, Kazuaki; Kitsuta, Yoichi; Nakajima, Susumu; Umezu, Mitsuo; Yahagi, Naoki.

    In: BMJ Open, Vol. 3, No. 9, e003354, 2013.

    Research output: Contribution to journalArticle

    Inokuchi, R, Sato, H, Nanjo, Y, Echigo, M, Tanaka, A, Ishii, T, Matsubara, T, Doi, K, Gunshin, M, Hiruma, T, Nakamura, K, Shinohara, K, Kitsuta, Y, Nakajima, S, Umezu, M & Yahagi, N 2013, 'The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: A pilot study', BMJ Open, vol. 3, no. 9, e003354. https://doi.org/10.1136/bmjopen-2013-003354
    Inokuchi, Ryota ; Sato, Hajime ; Nanjo, Yuko ; Echigo, Masahiro ; Tanaka, Aoi ; Ishii, Takeshi ; Matsubara, Takehiro ; Doi, Kent ; Gunshin, Masataka ; Hiruma, Takahiro ; Nakamura, Kensuke ; Shinohara, Kazuaki ; Kitsuta, Yoichi ; Nakajima, Susumu ; Umezu, Mitsuo ; Yahagi, Naoki. / The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units : A pilot study. In: BMJ Open. 2013 ; Vol. 3, No. 9.
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    abstract = "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.",
    author = "Ryota Inokuchi and Hajime Sato and Yuko Nanjo and Masahiro Echigo and Aoi Tanaka and Takeshi Ishii and Takehiro Matsubara and Kent Doi and Masataka Gunshin and Takahiro Hiruma and Kensuke Nakamura and Kazuaki Shinohara and Yoichi Kitsuta and Susumu Nakajima and Mitsuo Umezu and Naoki Yahagi",
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    T1 - The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units

    T2 - A pilot study

    AU - Inokuchi, Ryota

    AU - Sato, Hajime

    AU - Nanjo, Yuko

    AU - Echigo, Masahiro

    AU - Tanaka, Aoi

    AU - Ishii, Takeshi

    AU - Matsubara, Takehiro

    AU - Doi, Kent

    AU - Gunshin, Masataka

    AU - Hiruma, Takahiro

    AU - Nakamura, Kensuke

    AU - Shinohara, Kazuaki

    AU - Kitsuta, Yoichi

    AU - Nakajima, Susumu

    AU - Umezu, Mitsuo

    AU - Yahagi, Naoki

    PY - 2013

    Y1 - 2013

    N2 - 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.

    AB - 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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