by Mimi Zander
When I arrived back at the Children’s Hospital of Philadelphia (CHOP) after my first year of medical school, I knew what was awaiting me: thousands of alarms from physiologic monitors, most of them inconsequential, lined up neatly in spreadsheets, splattered all over research databases, lighting up on video screens, chirping down hallways and up elevators. Of course, they were incessantly firing at the bedside, but when patient care is video recorded for Dr. Bonafide’s research study on alarm fatigue, those patient care hours turn into data points that live on hard drives and servers waiting to be classified, annotated, and cataloged by a team of research assistants, including me.
I began working at the CHOP while attending the University of Pennsylvania’s post-baccalaureate premed program. What started as a temporary summer research position, turned into an almost three year endeavor. The pilot that I helped design uses video cameras in hospitalized patient rooms to record patient care. We download the video, edit it so we can review multiple viewing angles at one time, download a spreadsheet of all of the alarms that fired during the study period, and then with a little patience and some subtraction, we can line up every alarm that fired with the video clip. That’s the easy part.
This small pilot has transformed into a much larger study with a much larger volume of alarms. Since I started medical school last July, the research team has steadily collected video data all year. With support from SHM’s student scholar grant program, I have been able to return to CHOP for the summer. And now the video review begins.
It is tedious to evaluate every SPO2, PVC, heart rate, or respiratory rate alarm that fires. But it’s much more tedious to be a nurse on the floor being bombarded with hundreds of alerts to a problem that is not “real” while taking care of other patients. Alarm fatigue is a phenomenon where nurses and other clinicians will ignore or respond more slowly to an alarm if it is preceded by many false alarms (think The Boy Who Cried Wolf). The problem is so widespread that Emergency Care Research Institute (ECRI) lists “Alarm Hazards” (for the fourth year in a row) as their number one health technology hazard.
It’s clear from observing a hospitalized patient hooked up to a monitor that our monitoring devices are problematic, to say the least. When an alarm fires, it should indicate a change in the patient’s status that requires an intervention or a change in management. I can safely say that the past couple thousand alarms I’ve looked at this week have alerted no one to nothing. But there they are, sitting neatly in our database and firing at the bedside.
So, is it tedious? Yes. Is it important? Absolutely.
I’m empowered by every inconsequential alarm that I annotate in our database. Every false alarm that we recognize is one step closer to safer monitoring systems that do not bury clinically important alerts in noise. We will be successful if our work influences standards of care or alerts device manufacturers to change their alarm algorithms. For now though, we need to start by raising awareness of the noisy patient care environments that we are creating and begin to rethink how we can purposefully interact with the technologies that surround us.
For more information on the work we are doing at the Children’s Hospital of Philadelphia:
Mimi Zander is a rising second year student at the Touro College of Osteopathic Medicine in Harlem, New York City. She is one of three medical students to receive SHM’s Student Hospitalist Scholar Grant with which she is completing scholarly work related to patient safety in the hospital. Mimi received her B.A. from Rutgers University in 2011 with a concentration in English, and she completed her post baccalaureate studies at the University of Pennsylvania.