CHOP's patient safety team recognized for work alarm fatigue in hospital units

A patient safety team at The Children's Hospital of Philadelphia who analyzed the problem of alarm fatigue in hospital units has been recognized for the best research paper of 2014 in a journal dedicated to biomedical technology.

The Association for the Advancement of Medical Instrumentation (AAMI) selected the study "Video Methods for Evaluating Physiologic Monitor Alarms and Alarm Responses" as the best research published in the AAMI's journal, Biomedical Instrumentation & Technology.

Christopher Bonafide, M.D., MSCE, an attending pediatrician at CHOP, led the study, co-authored with 10 collaborators from the CHOP team. Andrew Rich, one of those co-authors, will accept the team's award at the AAMI conference next month in Denver.

Hospitalized children are attached to electronic monitors intended to detect any deviation from normal vital signs in the patient's heart and respiratory functions. But because the vast majority of alarms are false, nurses and other hospital staff may become desensitized to the constant buzzing and beeping--for some patients, hundreds of times a day.

The staff develops alarm fatigue, with the risk of failing to respond quickly or at all to an alarm that signal a genuine physiological problem. "Physiologic monitors and other medical devices have tremendous potential to save lives," said Bonafide. "Unfortunately, due in part to their design and in part to how hospitals use them, they generate so many false alarms that clinicians lose trust in them."

Healthcare organizations and regulators have increasingly recognized that alarm fatigue is a patient safety issue. The Joint Commission, the nonprofit group that accredits over 20,000 U.S. hospitals and healthcare facilities, has designated measures to improve alarm management a National Patient Safety Goal, and is requiring accredited hospitals to improve their alarm management systems by 2016.

Bonafide noted that little systematic research has previously measured alarms and responses in the hospital setting. Hence the CHOP team of physicians, nurses, engineers, and researchers performed a video-based study in the hospital's inpatient units. "Analyzing the magnitude and specifics of the alarm fatigue problem is the first step to designing effective interventions," he said. "We used delays in clinician response times as a proxy for alarm fatigue."

The team mounted video cameras in patient rooms. The cameras captured simultaneous views of the room, a close-up view of the patient, and views of the monitor screens, ventilator displays, and caregivers responding to the alarms. Researchers then analyzed and classified the alarms and staff responses, in a total of 40 video sessions covering nearly 5,000 alarms.

As might have been expected, the caregiver response times increased as the number of false alarms increased. In the general inpatient wards, the team classified 99 percent of the alarms as false. The pediatric intensive care unit, housing heart and lung failure patients, had a false alarm rate of 86.7 percent.

"Now that we are convinced that alarm fatigue is real, we need to begin the hard work of reducing alarm fatigue," said Bonafide. He added, "To do this, we need to work within our own institutions and across institutions to develop and test new interventions to improve the ways we manage alarms. It is also critical that we work with leaders in the medical device industry to actively participate in designing the next generation of monitors with smarter alarms."

The CHOP team followed its 2014 study with two others published this year on other aspects of alarm fatigue, and has continued to attract professional recognition.

The ECRI Institute, a research organization that evaluates medical devices, procedures and processes, recently named the team's 2014 study a finalist for its 9th annual Health Devices Achievement Award. Bonafide also received a 2015 Young Investigator Award from the Academic Pediatric Association for the team's work. Finally, the National Heart, Lung and Blood Institute selected Bonafide for a five-year career development award to further investigate alarm fatigue.

In addition to his CHOP title, Bonafide is on the faculty of the Perelman School of Medicine at the University of Pennsylvania.