Improving alarm performance in the medical intensive care unit using delays and clinical context

Abstract

Introduction: In an intensive care unit, alarms are used to call attention to a patient, to alert a change in the patient's physiology, or to warn of a failure in a medical device; however, up to 94% of the alarms are false. Our purpose in this study was to identify a means of reducing the number of false alarms.

Methods: An observer recorded time-stamped information of alarms and the presence of health care team members in the patient room; each alarm response was classified as effective (action taken within 5 min), ineffective (no response to the alarm), and ignored (alarm consciously ignored or actively silenced).

Results: During the 200-h study period, 1271 separate entries by an individual to the room being observed were recorded, 1214 alarms occurred and 2344 tasks were performed. On average, alarms occurred 6.07 times per hour and were active for 3.28 min per hour; 23% were effective, 36% were ineffective, and 41% were ignored. The median alarm duration was 17 s. A 14-s delay before alarm presentation would remove 50% of the ignored and ineffective alarms, and a 19-s delay would remove 67%. Suctioning, washing, repositioning, and oral care caused 152 ignored or ineffective ventilator alarms.

Discussion: Introducing a 19-s alarm delay and automatically detecting suctioning, repositioning, oral care, and washing could reduce the number of ineffective and ignored alarms from 934 to 274. More reliable alarms could elicit more timely response, reduce workload, reduce noise pollution, and potentially improve patient safety.