The real cost of alarm fatigue - Help Net Security

HM Epstein hmepstein at GMAIL.COM
Mon Sep 4 00:29:32 UTC 2017


All excellent points, Peter. My analogy was simply to say that the go-no go decisions for when an alarm is required for an airplane are simpler and more mechanical than the same for a hospitalized human patient. 
Best,
Helene

On Sep 3, 2017, at 6:22 PM, Peter Dayton MD <pdayton at comcast.net> wrote:

The issue is not that people are not airplanes. The issue is the human interaction with machines. Alarm fatigue is a real think. Cockpit Resource Management , CRM , is an  attempt to limit pilot workload to the essential functions and limit distractions.  I note a lot of monitoring devices in ICUs have audible alarms at the bedside but not remote alarms vis Bluetooth or Wi-Fi to a remote device with a silencing device at the bedside. ICUs are really not designed to isolate sound. It would be great to have an acoustic engineer study a typical ICU , design soundproofing and baffling to let patients have quiet without compromising the level of surveillance needed to care for them. Just a thought.
 
 
Peter M. Dayton MD
Medical Director of Patient Safety and Quality
Martin Health Systems
1815 Kanner Highway
Stuart FL 34994
peter.dayton at martinhealth.org
772-285-4020 cell
772-288-2999 fax
Our mission is to provide exceptional health care, hope and compassion to every person, every time.
1 Peter 3:15
 
 
 
From: HM Epstein [mailto:hmepstein at GMAIL.COM] 
Sent: Saturday, September 2, 2017 7:13 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] The real cost of alarm fatigue - Help Net Security
 
First of all Andrea, I'm so sorry you had to go through all of that. I hope they were able to identify the cause of the blood pressure drop so you don't have to deal with it again. Also, every patient needs rest. It is an essential part of the healing process. To have alarms going off repeatedly can't have helped. Nor feeling that your medical history was ignored. 
 
I often hear the comparisons drawn to the aerospace industry. It would be wonderful if we could get there but I wonder if we can. Humans are not airplanes and we don't respond the same way to, say blood pressure, the way an airplane responds to air pressure. Perhaps when precision medicine has been accurately applied to all diseases, we can have a better fix on what needs to be watched for in every patient. 
 
I'm wondering whether there are ways to code the alarms to match a patient's particular issue and medical history. Will the computer literate amongst us be able to tell me if we can create an algorithm to program the key elements of a patient's medical history and current situation in so that only certain alarms are sit on and, when necessary, triggered?
 
Best,
Helene 
 

On Sep 2, 2017, at 7:46 AM, Andrea Borondy Kitts <borondy at MSN.COM> wrote:

I just had major surgery; right hip revision and left hip replacement. My blood pressure tanked and they were unable to control without meds so I had to spend 24 hours in ICU. 
Alarms went off every 5-10 minutes. They set my pulse alarm to 45 despite my advising them I typically run in the low 40's when at rest. It went off every 5 minutes and never triggered any action. After 8 hours of false alarms they finally changed it.
 
A good model to use would be the aerospace industry. A lot of quality measures and design input are used to minimize false alarms for pilots and maintainers. 
 


Sent from my iPhone

On Sep 1, 2017, at 11:13 PM, Lori Harmon <lharmon at SCCM.ORG> wrote:

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
t: +1 847.493.6403 | m: +1 847.693.0359 | www.sccm.org
www.facebook.com/SCCM1 | www.twitter.com/SCCM | www.youtube.com/SCCM500

Visit www.survivingsepsis.org and www.iculiberation.org
 
 
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> 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]
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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