Impact of a Safety Huddle–Based Intervention on Monitor Alarm Rates in Low-Acuity Pediatric Intensive Care Unit Patients
BACKGROUND: Physiologic monitors generate high rates of alarms in the pediatric intensive care unit (PICU), yet few are actionable.
OBJECTIVE: To determine the association between a huddle-based intervention focused on reducing unnecessary alarms and the change in individual patients’ alarm rates in the 24 hours after huddles.
DESIGN: Quasi-experimental study with concurrent and historical controls.
SETTING: A 55-bed PICU.
PARTICIPANTS: Three hundred low-acuity patients with more than 40 alarms during the 4 hours preceding a safety huddle in the PICU between April 1, 2015, and October 31, 2015.
INTERVENTION: Structured safety huddle review and discussion of alarm causes and possible monitor parameter adjustments to reduce unnecessary alarms.
MAIN MEASUREMENTS: Rate of priority alarms per 24 hours occurring for intervention patients as compared with concurrent and historical controls. Balancing measures included unexpected changes in patient acuity and code blue events.
RESULTS: Clinicians adjusted alarm parameters in the 5 hours following the huddles in 42% of intervention patients compared with 24% of control patients (P = .002). The estimate of the effect of the intervention adjusted for age and sex compared with concurrent controls was a reduction of 116 priority alarms (95% confidence interval, 37-194) per 24 hours (P = .004). There were no unexpected changes in patient acuity or code blue events related to the intervention.
CONCLUSION: Integrating a data-driven monitor alarm discussion into safety huddles was a safe and effective approach to reducing alarms in low-acuity, high-alarm PICU patients. Journal of Hospital Medicine 2017;12:652-657. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
CONCLUSION
Integrating a data-driven monitor alarm discussion into safety huddles was a safe and effective approach to reduce alarms in low-acuity, high-alarm PICU patients. Innovative approaches to make data-driven alarm decisions using informatics tools integrated into monitoring systems and electronic health records have the potential to facilitate cost-effective spread of this intervention.
Disclosure
This work was supported by a pilot grant from the Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia. Dr. Bonafide is supported by a Mentored Patient-Oriented Research Career Development Award from the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL116427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations or employers. The funding organizations had no role in the design, preparation, review, or approval of this paper, nor the decision to submit for publication.
