A new approach to alarm management: mitigating failure-prone systems

Abstract

Alarm management that effectively reduces alarm fatigue and improves patient safety has yet to be convincingly demonstrated. The leaders of our newly constructed children’s hospital envisioned and created a hospital department dedicated to tackling this daunting task. The Clinical Logistics Center (CLC) is the hospital’s hub where all of its monitoring technology is integrated and tracked twenty-four hours a day, seven days a week by trained paramedics. Redundancy has been added to the alarm management process through automatic escalation of alarms from bedside staff to CLC staff in a timely manner. The paramedic alerting the bedside staff to true alarms based on good signal quality and confirmed by direct visual confirmation of the patient through bedside cameras distinguishes true alarms from nuisance/false alarms in real time. Communication between CLC and bedside staff occurs primarily via smartphone texts to avoid disruption of clinical activities. The paramedics also continuously monitor physiologic variables for early indicators of clinical deterioration, which leads to early interventions through mechanisms such as rapid response team activation. Hands-free voice communication via room intercoms facilitates CLC logistical support of the bedside staff during acute clinical crises/resuscitations. Standard work is maintained through protocol-driven process steps and serial training of both bedside and CLC staff. This innovative approach to prioritize alarms for the bedside staff is a promising solution to improving alarm management.