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Crit Care Med. 1997 Apr;25(4):614-9.

Poor prognosis for existing monitors in the intensive care unit.

Author information

1
MIT Laboratory for Computer Science, Harvard-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge 02139, USA.

Abstract

OBJECTIVE:

To identify areas requiring the most urgent improvement in the intensive care unit (ICU); and to accurately determine the positive predictive value of routine critical care patient monitoring alarms, as well as the common causes for false-positive alarms.

DESIGN:

Prospective, observational study.

SETTING:

A multidisciplinary ICU in a university-affiliated children's hospital (excluding children with primary heart disease).

INTERVENTIONS:

The occurrence rate, cause, and appropriateness of all alarms from tracked monitors were recorded by a trained observer and validated by the bedside nurse over a 10-wk period for a single bedspace at a time.

MEASUREMENTS AND MAIN RESULTS:

After 298 monitored hrs, 86% of a total 2,942 alarms were found to be false-positive alarms, while an additional 6% were classified as clinically irrelevant true alarms. Only 8% of all alarms tracked during the study period were determined to be true alarms with clinical significance. Alarms were also classified according to whether they were clearly associated with a "patient intervention" (18%), were clearly not associated with a patient intervention (74%), or had unclear association to interventions (8%). While 11% of "nonpatient intervention" alarms were clinically significant true alarms, only 2% of "patient intervention" alarms were so. Positive predictive values for the various devices ranged from < 1% for the pulse oximeter's heart rate signal to 74% for the arterial catheter's mean systemic blood pressure signal during periods free from patient interventions. The pulse oximeter caused false-positive alarms most frequently, with common reasons being bad data format/bad connection and poor contact.

CONCLUSION:

Efforts to develop intelligent monitoring systems have more potential to deliver significantly improved patient care by initially targeting especially weak areas in ICU monitoring, such as pulse oximetry reliability.

PMID:
9142025
[Indexed for MEDLINE]

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