New Monitoring Alarm Challenges and Opportunities for Collaborative Progress AAMI Alarms Summit October 4-5, 2011 Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare
NEW MONITORING ALARM CHALLENGES THE ACUTE CARE FLOOR Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 2
Why would we want to monitor patients on the floor anyway? Melbourne: all critical events (cardiac arrest/death/emergency ICU admission) were preceded by warning clinical signs for an average of 6.5 hours MJA 1999; 171: 22-25 Miami: Cardiac Arrests - 84% had instability for 8 hours prior to the event Chest 1990; 98: 1388-92 Chicago: Of 150 cardiac arrests 99 (66%) had documented instability for 8 hours prior to the event Crit Care Med 1994; 22: 244-247 Rinaldo Bellomo Live patients are easier to resuscitate than dead ones personal communication 2011 Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 3
Alarm Type Distribution ICU Acute Care floor Bradycardia Desat SpO2 Leads fail Tachycardia RR leads fail Heart rate low Heart rate high Oxygen saturation low HR Rhythm RR Pulse Other HR high HR low Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms. Graham KC, Cvach M, 19: 28-34, Am J Crit Care. 2010. Gross B, Dahl D, Nielsen L Physiologic monitoring alarm load on Medical/Surgical floors of a community hospital. 29-36 AAMI Horizons, Spring 2011. Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 4
Alarms and Monitoring Environment alarms/minute 2.5 2 2 1.5 1.57 15 bed ICU (1) 1 0.65 0.9 30 bed Ped ICU (2) 30 bed floor (3) 0.5 0.37 0 Pre intervention Post intervnetion 1.Graham KC, Cvach M, Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms., 19: 28-34, Am J Crit Care. 2010 2. Talley B, Hooper J, Jacobs B, Guzzetta C, McCarter R, Sill A, Cain S, Wilson SL, Cardiopulmonary Monitors and Clinically Significant Events in Critically Ill Children, 38-45 AAMI Horizons Spring 2011. 3. Gross B, Dahl D, Nielsen L, Physiologic monitoring alarm load on Medical/Surgical floors of a community hospital. 29-36 AAMI Horizons, Spring 2011. Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 5
Alarms and Monitoring Environment normalized for unit size alarms/minute 2.5 2 2 1.5 1.3 1.57 30 bed ICU (1) 1 0.9 0.74 30 bed Ped ICU (2) 30 bed Floor (3) 0.5 0 Pre intervention Post Intervention 1.Graham KC, Cvach M, Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms., 19: 28-34, Am J Crit Care. 2010 2. Talley B, Hooper J, Jacobs B, Guzzetta C, McCarter R, Sill A, Cain S, Wilson SL, Cardiopulmonary Monitors and Clinically Significant Events in Critically Ill Children, 38-45 AAMI Horizons Spring 2011. 3. Gross B, Dahl D, Nielsen L, Physiologic monitoring alarm load on Medical/Surgical floors of a community hospital. 29-36 AAMI Horizons, Spring 2011. Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 6
Alarm Sound Exposure in perspective ICU 1 alarm every 92 seconds after intervention Assume: 60 second response time to silence 32 seconds of silence between alarms Alarms don t occur at the same time The math 28800 seconds in an 8hr shift 313-92 sec segments in an 8hr shift 18780 seconds with alarm 10016 seconds without alarm 166 minutes of silence/ 8 hour shift (2.7 hrs) 313 minutes of alarm sound/ 8 hour shift (5.2 hrs) Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms. Graham KC, Cvach M, 19: 28-34, Am J Crit Care. 2010. Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 7
Alarm Sound Exposure the reality on the floor Floor One alarm every 38 seconds Assume Response time 60 seconds Every minute there is 38 seconds with one alarm and 22 seconds with 2 alarms One continuous alarm sound an alarm saturated environment 306 minutes of one alarm sounding/ 8 hr shift (5.1 hours) 174 minutes of 2 alarms sounding/ 8hr shift (2.9 hrs) Impact on Caregivers Impact on PATIENTS Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 8
Opportunities for COLLABORATIVE PROGRESS Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 9
Research and Resource Shortfalls and Opportunities a Gold Standard data set for alarms development and testing Reliable data from different patient care environments Reliable clinical annotation Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 10
Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 11
An opportunity for collaboration MIMIC II (Version 3 - August 2011) 21,422 records - with full-icu stay waveforms and alarms. 3500 with related physiologic data/documentation and outcomes Discharge DX s Labs Linked to Social Security outcomes DB Publicly available through Physionet Requires reliable annotation Collaboration tools available via Physionet e.g. the MIT-BIH arrhythmia Database 48 fully annotated half-hour two-lead ECGs The gold standard for arrhythmia algorithm development Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 12
An opportunity for collaboration Remaining Gold Standard DB needs Annotated data from various patient populations and settings Inpatient Neonatal Pediatric Obstetrical Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 13
Contact: Frassica@MIT.edu Joseph J. Frassica, MD VP and Chief Medical Information Officer - Philips Healthcare 14