POOR-PROGNOSIS FOR EXISTING MONITORS IN THE INTENSIVE-CARE UNIT

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: Prospe ctive, observational study. Setting: A multidisciplinary ICU in a univ ersity-affiliated children's hospital (excluding children with primary heart disease). Interventions: The occurrence rate, cause, and approp riateness of all alarms from tracked monitors were recorded by a train ed 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-pos itive alarms, while an additional 6% were classified as clinically irr elevant true alarms. Only 8% of all alarms tracked during the study pe riod were determined to be true alarms with clinical significance. Ala rms were also classified according to whether they were clearly associ ated with a ''patient intervention'' (18%), were clearly not associate d with a patient intervention (74%), or had unclear association to int erventions (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 r anged from <1% for the purse oximeter's heart rate signal to 74% for t he arterial catheter's mean systemic blood pressure signal during peri ods free from patient interventions. The pulse oximeter caused false-p ositive alarms most frequently, with common reasons being bad data for mat/bad connection and poor contact. Conclusion: Efforts to develop in telligent monitoring systems have more potential to deliver significan tly improved patient care by initially targeting especially weak areas in ICU monitoring, such as pulse oximetry reliability.