In the hospital room of a very sick patient, or down the hall in a bustling ICU, medical personnel are constantly reaching out impatiently to switch off an alarm they find irrelevant or annoying.
What percentage of those alarms would you guess are false? Thirty percent?
Try up to 99%, according to national studies of hospital procedures.
High rates of false alarms lead to alarm fatigue, a phrase that reflects both a dangerous tuning out by care providers and an erosion of patients’ state of mind. Providers start to ignore medical alarms they’ve grown to learn are false or overly reactive to the case at hand. Meanwhile, patients’ primary hospital complaint is that they can’t rest when they are constantly prodded by human or machine intervention.
“The issue with bedside alarms is that there are too many, and they are too sensitive,” said Dr. Richard Zane, chief innovation officer for 16 UCHealth hospitals in three states, with more than 24,000 employees and nearly 2,000 beds.
Academic studies have shown for years that attacking alarm fatigue systematically can improve both patient care and patient satisfaction. UCHealth’s innovation team decided to take this on while confronting sepsis, one of the deadliest and most intractable problems in any medical system.
Sepsis, a blood-borne bacterial or viral infection that when unchecked causes “cascading” organ failure, is the cause of 1 out of 3 hospital deaths. Hundreds of Coloradans die from it every year. Nationwide, there are 1.7 million cases of hospital sepsis a year, causing 270,000 deaths.
Hospitals build algorithms based on patients’ vital signs and case history that can warn them when a very sick person is vulnerable to sepsis. But the symptoms of sepsis — low blood pressure, confusion, fever, shortness of breath — look like a hundred other illnesses, and the algorithms set off alarms for many patients who are not actually septic.
UCHealth had the advantage of a multimillion-dollar virtual surveillance center, set up in Aurora. The center deploys roomfuls of computer screens that are watched over by aides, nurses and physicians, taking feeds from individual patient monitors up to hundreds of miles away. UCHealth routed information on patients at risk for sepsis, no matter where they were, through the Aurora office park. Most alarms were silenced locally and handled by the Aurora staff.
And they could make sure detailed protocols were followed in every hospital — best practices in sepsis treatment involve a “bundle” of seven interventions, encompassing 141 different “tasks” to carry them out properly.
The results, peer-reviewed and soon to be published in a medical journal, were dramatic. UCHealth’s study logged 231 new cases of sepsis at system hospitals from October 2019 through February 2020, just before the coronavirus pandemic hit Colorado hard. Researchers compared the outcomes of the cases monitored centrally with results from 335 traditional cases in the year before the intervention started.
The time from sepsis onset to administering antibiotics — one key to extremely time-sensitive sepsis — fell from 92 minutes before the new centralized protocols to 59 minutes under the new regime. Mortality dropped 9 percentage points, to 21% of sepsis patients from 30% of sepsis patients, potentially saving hundreds of lives in Colorado if more hospitals are able to implement similar protocols.
And those alarms? The UCHealth system cut out more than 180,000 on-site alarms for the patients under study.
Wrapping up just as seriously ill COVID-19 patients started showing up at hospitals, the study proved “prophetic” for improving pandemic care, Zane said. “Going in and out of a patient’s room” for an alarm during COVID-19 “was a big deal,” he said. Double gloves, double face shields, double plastic suits, “double everything.”
“You’d tend to not want to go into a room when the alarm was going off,” Zane said. “Luckily, we already had the capacity to do this.”
UCHealth is now deploying what it learned about centralizing surveillance of sepsis to other hospital routines that also produce excessive alarms. One promising area, Zane said, is capnography, or measuring carbon dioxide in a patient’s exhaled breath. Too much or too little indicates a problem, but as with sepsis, alarms go off constantly when there’s nothing dramatic wrong.
Watching carefully is especially important for patients with opioids in their system that can impact breathing. Routing the sensors to screens in Aurora, Zane said, means that “now I don’t have to wait for your heart to stop, I know this is bad and I can intervene. So we not only eliminate the alarm, but also the need for a bedside nurse to look at the device.”