Poole Sarah, Shah Nigam
Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA.
Biomed Inform Insights. 2019 Jan 10;11:1178222618818478. doi: 10.1177/1178222618818478. eCollection 2019.
Bedside monitors are intended as a safety net in patient care, but their management in the inpatient setting is a significant patient safety concern. The low precision of vital sign alarm systems leads to clinical staff becoming desensitized to the sound of the alarm, a phenomenon known as alarm fatigue. Alarm fatigue has been shown to increase response time to alarms or result in alarms being ignored altogether and has negative consequences for patient safety. We present methods to establish personalized thresholds for heart rate and respiratory rate alarms. These thresholds are first chosen based on patient characteristics available at the time of admission and are then adapted to incorporate vital signs observed in the first 2 hours of monitoring. We demonstrate that the adapted thresholds are similar to those chosen by clinicians for individual patients and would result in fewer alarms than the currently used age-based thresholds. Personalized vital sign alarm thresholds can help to alleviate the problem of alarm fatigue in an inpatient setting while ensuring that all critical vital signs are detected.
床边监护仪旨在作为患者护理中的安全保障，但在住院环境中对其管理却是一个重大的患者安全问题。生命体征报警系统的低精度导致临床工作人员对警报声变得麻木，这种现象被称为警报疲劳。研究表明，警报疲劳会增加对警报的响应时间，或者导致警报被完全忽略，对患者安全产生负面影响。我们提出了为心率和呼吸率警报建立个性化阈值的方法。这些阈值首先根据入院时可用的患者特征来选择，然后进行调整，纳入监测开始后两小时内观察到的生命体征。我们证明，调整后的阈值与临床医生为个体患者选择的阈值相似，并且与当前使用的基于年龄的阈值相比，警报次数会更少。个性化的生命体征报警阈值有助于缓解住院环境中的警报疲劳问题，同时确保检测到所有关键生命体征。
