Incorporating Observed Physiological Data to Personalize Pediatric Vital Sign Alarm Thresholds

Biomed Inform Insights. 2019 Jan 10:11:1178222618818478. doi: 10.1177/1178222618818478. eCollection 2019.


Bedside monitors are intended as a safety net in patient care, but their management in the inpatient setting is a significant patient safety concern. The low precision of vital sign alarm systems leads to clinical staff becoming desensitized to the sound of the alarm, a phenomenon known as alarm fatigue. Alarm fatigue has been shown to increase response time to alarms or result in alarms being ignored altogether and has negative consequences for patient safety. We present methods to establish personalized thresholds for heart rate and respiratory rate alarms. These thresholds are first chosen based on patient characteristics available at the time of admission and are then adapted to incorporate vital signs observed in the first 2 hours of monitoring. We demonstrate that the adapted thresholds are similar to those chosen by clinicians for individual patients and would result in fewer alarms than the currently used age-based thresholds. Personalized vital sign alarm thresholds can help to alleviate the problem of alarm fatigue in an inpatient setting while ensuring that all critical vital signs are detected.

Keywords: Alarm fatigue; Clinical informatics; Inpatient monitoring; Vital signs.