It's not about the alarms! -...
Transcript of It's not about the alarms! -...
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keeping an eye on life.
Surveillance Monitoring System
It’s not about the alarms!
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25-75% ofadverse eventsand preventabledeaths occuroutside of the ICU in unmonitored beds1
• Up to 60% of non-ICU beds are unmonitored2
• 84% of patients exhibit signs of deterioration within 8 hours preceding cardio-pulmonary arrest3
1 http://www.ihi.org/education/conferences/APACForum2012/Documents/I2_Presentation_Diagnostics_Haraden.pdf
2 AHA database, 2013 3 Schein RM et al. Clinical antecedents to in-hospital cardiopulmonary arrest.
Chest 1990;98:1388-92.
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• Approximately 5% of hospital admissions have an unexpected transfer to the ICU*
• For every 1 hour increase in transfer delay, the odds of an in-‐hospital death increased 3%
• For pa?ents who survived un?l discharge, delayed transfer was associated with a longer length of stay.
Wendlandt, B et al. Association between ICU Transfer Delay and Hospital Mortality: A Multicenter Investigation (abstract). Journal or Hospital Medicine 2015:10 (suppl 2).
*Churpek,M et all. Multicenter Development and Validation Tool for Ward Patients. American Journal of Respiratory and Critical Care Medicine. Vol 190 No 6. Sept 15, 2014
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Rapid Response Systems
ICU
General Floor
Professor Kenneth Hillman, AO
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Conditional versus Surveillance Monitoring
Condi6onal Monitoring (ICU)
• Pa?ent has risk factors
• Monitoring as ordered
• Specialized monitoring
• Targeted measures (cardiac telemetry for cardiac pa?ents)
• High-‐risk popula?on
• Special wards
Surveillance Monitoring (General Floor)
• Environment has risk factors
• Monitoring as standard of care
• General monitoring
• Mul?-‐parameter measurements (HR, RR, BP, SpO2, etc)
• Lower-‐risk popula?on
• General care wards
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Optimizing Alarms for Surveillance Monitoring
Objectives: 1. Detect patient deterioration 2. Alarm only on clinically actionable events
• Requires beside intervention • Reverses an emerging harmful event
3. Build large data base • Optimize alarm configuration settings • Develop strategies to reduce false alarms • Develop new “smart” alarm algorithms
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Optimizing Alarms for Surveillance Monitoring Methods: 1. Capture high fidelity physiologic data in
intended application across multiple hospitals • Capture and store data at the hospital • De-identify PHI • Transfer and store data in cloud
repository 2. Characterize distribution of each vital sign
under actual clinical use 3. Perform “what if” analysis across multiple
alarm configurations • Optimize threshold settings • Optimize alarm delays
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275,000 hours of pa?ent data
Predictive Analytics Alarm Configura6on
Alarm Performance De-‐iden?fy PHI
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Distribution of SpO2 values (general care wards)
90% 85%
Median = 96%
250 patients 8,400 hrs
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Combined impact of threshold and delay settings on SpO2 alarm
• Delays have the greatest overall benefit in reducing alarms
• 85% SpO2 alarm threshold represents 4 sigma from SpO2 median
• 60 sec delay lowers alarm rate to 2.8 alarm / pt / day
Data based on one institution, 15k hrs
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National Benchmark
• 275k+ hours
• 9500 pa?ent sessions
• 16 Hospitals
May 2015 Aggregate Analysis
Parameter Alarms
SpO2 3.01 Cardiac Rate 2.96
Respira6on Rate 0.55 NIBP 0.04 cNIBP 0.86 Total 7.42
Parameter High Alarm Low Alarm
Delay (sec)
SpO2 -‐-‐ 85 60 Cardiac Rate 150 30 30
Respira6on Rate 35 4 120 Systolic Blood Pressure 190 -‐-‐ 120 Mean Arterial Pressure -‐-‐ 60 60 Diastolic Blood Pressure -‐-‐ -‐-‐ -‐-‐
Jan – May 2015 Partner Hospital
Parameter Alarms
SpO2 1.84 Cardiac Rate 1.38
Respira6on Rate 0.47 NIBP 0.04 cNIBP 1.31 Total 5.03
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• 26 bed post surgical care unit • Policy to surveillance monitor all pa?ents • Data capture Feb 9, 2015 – May 31, 2015
delays thresholds Alms/pt/day
Best Practice Hospital
SpO2 OFF/90 OFF/85 1.14PR 60/60 150/29 0.3HR 15/15 150/29 2.69CR 60/60 150/29 1.27RR 120/120 35/4 0.38BP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.06
cNIBP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.43Total 3.29
SpO2 OFF/90 OFF/85 1.14PR 60/60 150/29 0.3HR 15/15 150/29 2.69CR 60/60 150/29 1.27RR 120/120 35/4 0.38BP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.06
cNIBP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.43Total 3.29
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Leading Indicator Report
• Generated for every ac?ve account every 2 weeks
• Reports alarm rates and # of sessions
• Nega?ve trends reported to the hospitals
• Correc?ve ac?on implemented before nuisance alarms are reported
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Thank you [email protected]