Brooklyn hospital’s ICU plagued by false cardiac monitor alarms
Intensive care units in hospitals are very noisy environments for clinicians to work in, with medical device alarms constantly going off—many of them false alarms, in essence, false positives. As a result, providers have become desensitized to these alarms, a phenomenon known as alarm fatigue.
No hospital knows this better than Maimonides Medical Center in Brooklyn, N.Y., where researchers analyzed the accuracy of cardiac monitor alarms in the ICU using the hospital’s standard protocol. What they found was that a large number of alarms are false without any clinical significance, despite following the standard protocol to reduce false-positive alarms.
Reducing the amount of alarms or dealing with alarm fatigue is a challenge for many healthcare organizations, particularly as alarms are delivered through electronic health records or clinical decision support systems.
In the Maimonides Medical Center study, 77 percent of the ICU’s cardiac monitor alarms were deemed to be false positive, while just 23 percent were true positive. Results from the study will be presented on Wednesday in Toronto at CHEST 2017, the annual meeting of the American College of Chest Physicians. Parita Soni, MD, internal medicine physician at Maimonides, is the lead author of the study.
The one-year study examined a total of 2,408 alarms that occurred among 350 patients, including critical life-threating cardiac alarms such as for asystole, tachycardia, bradycardia, ventricular tachycardia and ventricular fibrillation. Each alarm was studied retrospectively for the occurrence of an actual cardiac event suggested by the alarm.
“What we did was look at the alarms as flagged by the system to determine the accuracy of those alarms,” says Yizhak Kupfer, MD, the principal investigator and director of the medical ICU at Maimonides Medical Center.
Researchers discovered that the majority of the alarms for ventricular tachycardia (96.5 percent), asystole (about 90 percent), ventricular fibrillation (89.9 percent) and bradycardia (80.6 percent) were false positive, while most of the tachycardia alarms (84.4 percent) were true positive.
“The implication of this is that the staff really needs to advise ways to motivate each other to continue to respond to these alarms so that you don’t have the boy-who-cried-wolf syndrome,” adds Kupfer. “There is a certain amount of inaccuracy in any system, and the staff really needs to come up with motivating techniques to be able to continue to have good response times. It can be very frustrating when a little over three-quarters of the alarms are false positives and to continue to response to them. But it will be the one alarm that the staff doesn’t respond to which could be the fatal event.”
Although the authors of the article say it is “desirable for the cardiac monitor to have a high sensitivity,” they note that frequent alarms “may cause alarm fatigue of the medical personnel leading to delayed or no response to the alarms, which could jeopardize patient’s safety.” At the same time, the study observes that the “impact of following standard processes/protocols such as pertinent skin preparation, changing electrocardiogram (EKG) leads daily, customization of alarm parameters, and education of the nursing staff to reduce the false alarms remains unclear.”
According to Kupfer, a lot of the asystole false positives were a result of EKG leads falling off the patients. To address the problem, he says the recommendation to the staff is to change EKG leads more than once daily, especially for some patients who might be sweaty.
Researchers also conclude that there is a “pressing need of implementing an intelligent cardiac monitoring system in the ICUs.” In addition to “being highly sensitive, the alarm system should also take into account other parameters before beeping,” the authors conclude. “Reducing the number of false positive alarms would lead to increased efficiency of the nursing staff and other medical personnel; hence would improve the patient safety.”
Kupfer says one potential solution Maimonides Medical Center is considering is having a dedicated staff member to monitor alarms in the ICU. “That may be an approach that we’re going to be looking at to see whether that will impact upon our ability to respond,” he adds. “False positives do exist, but so do a significant number of real red alarms which are associated with life-threatening and potentially deadly outcomes.”