The real cost of alarm fatigue - Help Net Security

Lori Harmon lharmon at SCCM.ORG
Fri Sep 1 19:07:24 UTC 2017


Here is an interesting article from Critical Care Medicine on this topic. SCCM is evaluating the opportunity for further study in intensive care units although we understand alarm and alert fatigue is not just a problem in the ICU care setting but is a larger patient safety issue house wide. And its not just sepsis either. This is a systems problem – someone had an aha moment that if we set an alarm or alert the clinicians would pay attention, but wait lets do that for everything and make the alarms and alerts sensitive to common clinical triggers so they go off all the time. It’s the Deming milky way syndrome. Something of importance to tackle.

Lori

Lori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care Medicine
500 Midway Drive, Mount Prospect, IL 60056-5811 USA
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From: Tom Benzoni [mailto:benzonit at GMAIL.COM]
Sent: Friday, September 1, 2017 10:37 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] The real cost of alarm fatigue - Help Net Security

It's a huge issue.
I get a sepsis alert on (back of the envelope calculation) 25% of ER patients. Laceration. Teenager sore throat. Ankle sprain.
If I'm too fast on the enter key, I get page after page of irrelevant orders, prechecked, that I have to cancel.
This is plain set mathematics: If everyone screens (+) for sepsis, we won't miss anyone. Any abnormal vital sends a sepsis alert. Any. One. Vital. Sign.
Each of these alerts takes their toll on my decision capacity.
There is no reward for precision. The positive predictive value of these triggers is unstudied, but it has to be poor.
We do have EM research showing ~40% increase in ER administration of antibiotics for presumed pneumonia with no change in hospital discharge rate of pneumonia.
tom

On Fri, Sep 1, 2017 at 10:23 AM, Grubenhoff, Joe <Joe.Grubenhoff at childrenscolorado.org<mailto:Joe.Grubenhoff at childrenscolorado.org>> wrote:
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<mailto:hmepstein at GMAIL.COM>]
Sent: Friday, September 01, 2017 8:18 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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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