The real cost of alarm fatigue - Help Net Security

Grubenhoff, Joe Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
Fri Sep 1 15:23:01 UTC 2017


The struggle is real. Sit on any unit's nursing station and watch how often alarms go off without anyone (diagnosticians and others) glancing at a monitor or heading to a patient room...and it's not just life-sign monitoring equipment. It occurs with EHR alerts about meds and other care issues. We recently revamped our sepsis alert notification in our ED. Initially the trigger was Heart Rate >95%ile for age + fever. Since just about every kid with a fever is tachycardic the alert was triggered excessively often with very few true positives. So we switched to using hypotension. Far fewer false + . Since hypotension is a late finding, this change probably means we could miss kids early in their course of septic shock. It begs the question - like the article you reference - is it better to screen a lot of false positives where "there may be something wrong" or run the risk of raising the detection threshold to focus more on "there is clearly something wrong." Perhaps avoiding the workload responding to high-sensitivity low specificity alerts and, that work could be funneled into thinking about who is actually at risk.

jg 

BMC Med Inform Decis Mak. 2017 Apr 10;17(1):36. doi: 10.1186/s12911-017-0430-8.

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.

Ancker JS1,2,3, Edwards A4,5, Nosal S6,7, Hauser D6, Mauer E4, Kaushal R4,5; with the HITEC Investigators.

-----Original Message-----
From: HM Epstein [mailto:hmepstein at GMAIL.COM] 
Sent: Friday, September 01, 2017 8:18 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] The real cost of alarm fatigue - Help Net Security

https://www.helpnetsecurity.com/2017/09/01/real-cost-alarm-fatigue/

I was halfway through this article on alarm fatigue and misdiagnosis, before I realized it was about cyber attacks on complex computer systems and not about doctors and nurses caring for patients in a hospital system. Since I'm not a doctor or a nurse, I need to ask those of you who are, is this a relevant description of hospitalists' and ED staff's experience with alarm fatigue and the resulting risk of misdiagnosis from ignoring a trigger event?

Best,
Helene




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