Vanderbilt Summer Science Academy

Bedside Monitoring: Technical instability impacting patient safety

The dependability of monitors and responsiveness to clinical alarms are crucial issues of hospital care and patient safety. During a study analyzing the impact of a smart algorithm system, IPI (Integrated Pulmonary Index), on the nurse workflow of several general care floors, many technical issues detrimentally affected the alerting structure and in some instances worsened alarm fatigue. It remains unclear how to correctly address technical issues and alarm fatigue. This research investigates various ways an alarm can be disrupted or falsely activated during the signaling pathway from the patient to the nurse, clinical database, or the research database. The observations and results will inform future designs for accommodating similar complex monitoring systems into the hospital more successfully. During the study, 440 patients (220 before enabling IPI and 220 after enabling IPI) were observed. The IPI index uses the measurements of etCO2, SpO2, RR, and PR to produce an integer score of 1-10, indicative of the patient’s physiological status. The data were time stamped and stored with a unique subject ID. During the monitoring, the pathway of the alarm system was observed. The numerous factors that could lead to a disrupted pathway were investigated. The system could conceivably have points of failure anywhere along the signal pathway. The IPI index is an innovative system, yet the inconsistency of the system due to technical issues may hinder its benefits. Creating a consistent environment, void of technical issues, would enhance the utility of the IPI index system on a general care floor.