James P. Welch

An Evidence-Based Approach to Reduce Nuisance Alarms and Alarm Fatigue

decisions about where to program alarm settings, Masimo Corp. based in Irvine, CA conducted an analysis of 32 million pulse oximetry (SpO 2 ) data points from 10 hospital general post-surgical care areas. Each hospital was equipped with a Masimo Patient SafetyNetTM remote monitoring and clinician notification system, which continuously captures and stores time-stamped SpO 2 data with a one-second resolution. This paper reports on the results of a retrospective analysis conducted by the company to determine the incidence of alarms at various alarm threshold and delay settings.

A Wireless ECG Smart Sensor for Broad Application in Life Threatening Event Detection

A single channel wireless, wearable ECG smart sensor has been developed for long-term monitoring of patients at risk of life-threatening cardiac arrhythmias. The battery-operated sensor can be applied in virtually any orientation on the upper left quadrant of the chest, and monitors patient health continuously for up to three days. An embedded microcontroller calculates heart rate and monitors the ECG signal for life-threatening arrhythmias, which are transmitted wirelessly to a central server and relayed to a respondent device. Tests on human subjects demonstrated signal amplitude from the closely-spaced smart sensor electrodes to be one-half that of the best vector from traditional limb lead placement. Tests with motion and muscle artifact showed superior noise immunity by the smart sensor as compared to a state-of-the-art telemetry monitor.

Performance measures of ISM-band and conventional telemetry

The primary goal of this study is to quantify the communications reliability of telemetry systems using ISM-band two-way communications technology and contrast it to that of VHF/UHF-based systems from an empirical and clinical perspective. The principal criterion variable of communications reliability was total dropout proportion: the percentage of wireless patient monitoring time attributable to a loss of patient signal. Data from 17 institutions across the United States were included in this research. The data from this study were also used to explore potential relationships between communications reliability and various institutional factors. The institutional variables evaluated for possible adverse impact on ISM-band communications reliability included wireless coverage area, the number of telemetry transmitters supported, institutional experience with the product, gross institution size, and the number of telemetry systems within each hospital. The frequency-hopping communication technology utilized by the ISM-band products was not adversely affected by coexisting ISM-band devices. Institutions with shared ISM-band environments demonstrated a better - but statistically insignificant - performance difference both in terms of total dropout proportion and mean time between dropouts. Analysis showed no adverse affect on the communications reliability of ISM-band systems as a function of the number of telemetry transmitters supported, institution size, number of ISM-band telemetry systems within an institution, coverage area, or institutional experience with the system. In contrast, VHF/UHF installations showed statistically significant adverse impact on dropout proportion from two sources: the more transmitters supported, or the greater the coverage area, the higher the dropout proportion. The results from regression analysis at the institution-level should be interpreted cautiously since the statistical power was limited by the number of hospitals in the sample.

Early Detection of the Deteriorating Patient: The Case for a Multi-Parameter Patient-Worn Monitor

Scott McCombie, BSBSE, is research engineer at Sotera Wireless, San Diego, CA. E-mail: scott.mccombie@ soterawireless.com Effective, efficient, and safe delivery of healthcare is dependent on the timely identification and treatment of a deteriorating patient condition. Failure to rescue patients in the early stage of physiological deterioration can result in permanent organ injury, extended medical treatment, increased recovery time, or death. These avoidable adverse events drive healthcare costs up and quality down. The primary indicator of failure to rescue is unsuccessful cardiopulmonary resuscitation. The American Heart Association created a national registry of cardiopulmonary resuscitation (NPCPR) in 2000 as a voluntary evidence-based patient safety initiative. A review by Peberdy and colleagues of 14,720 cases of cardiopulmonary arrest from the NPCPR database collected between 2000 and 2002 shows the following breakdown of physiology, immediate cause, and discovery.

Framework for Alarm Management Process Maturity

Tandi Bagian, MSE, is program analysis officer in the National Center For Patient Safety of the Department of Veterans Affairs in Ann Arbor, MI. Email: tandi.bagian@va.gov Editor’s note: The AAMI Foundation’s National Coalition for Alarm Management Safety developed this framework for medical device alarm management. This article is intended to guide stakeholders in developing sustainable solutions and to serve as a foundation for discussions with hospital executives, healthcare technology managers, patient safety officers, and risk managers. The framework is not intended to be prescriptive but rather a guide for continuous improvement efforts to reduce nonactionable alarms of all types originating from medical devices.