title: Pattern discovery in critical alarms originating from neonates under intensive care.
abstract: Patient monitoring generates a large number of alarms, the vast majority of which are false. Excessive non-actionable medical alarms lead to alarm fatigue, a well-recognized patient safety issue. While multiple approaches to reduce alarm fatigue have been explored, patterns in alarming and inter-alarm relationships, as they manifest in the clinical workspace, are largely a black-box and hamper research efforts towards reducing alarms. The aim of this study is to detect opportunities to safely reduce alarm pressure, by developing techniques to identify, capture and visualize patterns in alarms. Nearly 500 000 critical medical alarms were acquired from a neonatal intensive care unit over a 20 month period. Heuristic techniques were developed to extract the inter-alarm relationships. These included identifying the presence of alarm clusters, patterns of transition from one alarm category to another, temporal associations amongst alarms and determination of prevalent sequences in which alarms manifest. Desaturation, bradycardia and apnea constituted 86% of all alarms and demonstrated distinctive periodic increases in the number of alarms that were synchronized with nursing care and enteral feeding. By inhibiting further alarms of a category for a short duration of time (30 s/60 s), non-actionable physiological alarms could be reduced by 20%. The patterns of transition from one alarm category to another and the time duration between such transitions revealed the presence of close temporal associations and multiparametric derangement. Examination of the prevalent alarm sequences reveals that while many sequences comprised of multiple alarms, nearly 65% of the sequences were isolated instances of alarms and are potentially irreducible. Patterns in alarming, as they manifest in the clinical workspace were identified and visualized. This information can be exploited to investigate strategies for reducing alarms.
authors.affiliation: Eindhoven University of Technology, Department of Industrial Design, Laplace 32, 5612 AZ Eindhoven, The Netherlands. Máxima Medical Center, Clinical Physics, Veldhoven, The Netherlands.
authors.forename: Rohan
authors.initials: R
authors.lastname: Joshi
authors.forename: Carola
authors.initials: C
authors.lastname: van Pul
authors.forename: Louis
authors.initials: L
authors.lastname: Atallah
authors.forename: Loe
authors.initials: L
authors.lastname: Feijs
authors.forename: Sabine
authors.initials: S
authors.lastname: Van Huffel
authors.forename: Peter
authors.initials: P
authors.lastname: Andriessen
mesh_terms: D001919:Bradycardia / Q000175:diagnosis; D056902:Clinical Alarms; D016000:Cluster Analysis; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010363:Pattern Recognition, Automated; D013997:Time Factors