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Weve done many columns on alarm fatigue and alarm management (see full list below) but the focus has been in ICUs, med/surg units, and the OR. One venue largely ignored has been the emergency room.
Now a new study (Fleischman 2019) has analyzed alarms in the emergency department and confirmed that, like in all other venues, many alarms are clinically irrelevant and only contribute to the problem of alarm fatigue. The study was based on 53 hours of observation by an ED physician and recorded patient characteristics, alarm type, staff response, whether the alarm was likely real or false, and whether it changed clinical management. There was a median of 18 alarms per hour of observation, and the median number of alarms per patient was 4. Amazingly, alarms changed clinical management in only 8 out of 1049 observed alarms (0.8%) and in 5 out of the 146 patients (3%). Moreover, staff did not observably respond to most alarms (63%).
The authors suggest that efforts at improving the clinical significance of alarms could focus on widening alarm thresholds, customizing alarms parameters for patients' clinical status, and on utilizing monitoring more selectively.
Prior Patient Safety Tips of the Week pertaining to alarm-related issues:
Fleischman, William et al. Emergency department monitor alarms rarely change clinical management: An observational study. The American Journal of Emergency Medicine 2019; Published online July 30, 2019