BedMasterEx software (Excel Medical Electronics, Inc, Jupiter, FL) was installed to store physiologic waveforms, vital signs (device-measured parameters), alarm settings, and monitor alarms in a relational database (SQL Server TM ). However, if the artifact continues, it will trigger an ‘‘Arrhythmia Suspend’’ alarm that completely suspends all (including lethal) arrhythmia detection, putting the patient in a unsafe environment. For example, a technical message on the monitor that says ‘‘Artifact’’ indicates a noisy ECG signal but it does not sound an audible alarm nor does it suspend arrhythmia detection. Moreover, these technical alarms may provide a sensitive marker to determine the efficacy of interventions such as optimal electrode regimens. Inaudible technical alarms may signal a problem that, if uncorrected, will lead to complete suspension of arrhythmia detection. Thus, they do raise concern about whether something is wrong and require thought about whether a response is necessary. Our rationale for collecting inaudible as well as audible alarms is that nurses (and sometimes patients) notice text message alarms displayed on the bedside monitor. In prior research, investigators have reported only on audible alarms because they are thought to contribute more to alarm fatigue than inaudible alarms. A special research version of CARESCAPE Gateway was built to collect comprehensive alarm data such as nurse-determined individual patient alarm settings and all unique alarms including message (inaudible) and technical alarms. The CARESCAPE Gateway system (GE Healthcare, Milwaukee, WI) enables study data to securely pass out of the network to an external server to be analyzed retrospectively. A closed network connects all bedside monitors and central monitoring stations. Each of the 77 ICU beds is equipped with a Solar 8000i bedside monitor (version 5.4 software, GE Healthcare, Milwaukee, WI) that acquires, processes, and stores data. Figure 2 illustrates the hospital infrastructure that was installed to automatically store the physiologic monitor data for the UCSF Alarm Study. The nurse pictured in Figure 1 has provided consent for publication. A major advantage of the waiver of patient consent is that all consecutive patients treated in these ICUs were included in the study no patients were excluded from the analysis. ![]() The UCSF Committee on Human Research approved the study with waiver of patient consent because all ICU patients have physiologic monitoring as part of their routine care and acquisition and storage of this data did not influence their clinical care. The patient populations treated in these five units span the breadth of clinical disorders (medical, surgical, cardiac, and neurologic) treated in a large tertiary- quaternary medical center as summarized in Table 1. The UCSF Alarm Study used a prospective data collection design with a state-of-the-art technology infrastructure to collect all available physiologic waveforms, computer vital sign measurements, clinician alarm settings, and alarms that occurred in the medical center’s five adult ICUs. developing solutions to address the problem of clinical alarm fatigue.
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