title: Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital.
abstract: BACKGROUND
  Alarm fatigue is reported to be a major threat to patient safety, yet little empirical data support its existence in the hospital.
  
  
  OBJECTIVE
  To determine if nurses exposed to high rates of nonactionable physiologic monitor alarms respond more slowly to subsequent alarms that could represent life-threatening conditions.
  
  
  METHODS
  Observational study using video.
  
  
  METHODS
  Freestanding children's hospital.
  
  
  METHODS
  Pediatric intensive care unit (PICU) patients requiring inotropic support and/or mechanical ventilation, and medical ward patients.
  
  
  METHODS
  None.
  
  
  METHODS
  Actionable alarms were defined as correctly identifying physiologic status and warranting clinical intervention or consultation. We measured response time to alarms occurring while there were no clinicians in the patient's room. We evaluated the association between the number of nonactionable alarms the patient had in the preceding 120 minutes (categorized as 0-29, 30-79, or 80+ alarms) and response time to subsequent alarms in the same patient using a log-rank test that accounts for within-nurse clustering.
  
  
  RESULTS
  We observed 36 nurses for 210 hours with 5070 alarms; 87.1% of PICU and 99.0% of ward clinical alarms were nonactionable. Kaplan-Meier plots showed incremental increases in response time as the number of nonactionable alarms in the preceding 120 minutes increased (log-rank test stratified by nurse P < 0.001 in PICU, P = 0.009 in the ward).
  
  
  CONCLUSIONS
  Most alarms were nonactionable, and response time increased as nonactionable alarm exposure increased. Alarm fatigue could explain these findings. Future studies should evaluate the simultaneous influence of workload and other factors that can impact response time.
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Christopher P
authors: CP
authors: Bonafide
authors: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Richard
authors: R
authors: Lin
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Miriam
authors: M
authors: Zander
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Christian Sarkis
authors: CS
authors: Graham
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Christine W
authors: CW
authors: Paine
authors: Department of Biomedical Engineering, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Whitney
authors: W
authors: Rock
authors: Department of Biomedical Engineering, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Andrew
authors: A
authors: Rich
authors: Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Kathryn E
authors: KE
authors: Roberts
authors: Department of Nursing, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Margaret
authors: M
authors: Fortino
authors: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Vinay M
authors: VM
authors: Nadkarni
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: A Russell
authors: AR
authors: Localio
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Ron
authors: R
authors: Keren
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D056902:Clinical Alarms / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D064648:Critical Care Nursing / Q000592:standards / Q000706:statistics & numerical data; D006333:Heart Failure / Q000451:nursing; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000451:nursing*; D015999:Multivariate Analysis; D009732:Nursing Care / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data*; D061214:Patient Safety; D010371:Pediatric Nursing / Q000592:standards / Q000706:statistics & numerical data; D011930:Reaction Time; D012131:Respiratory Insufficiency / Q000451:nursing; D000078329:Workforce