Developing a Scalable Annotation Method for Large Datasets That Enhances Alarms With Actionability Data to Increase Informativeness: Mixed Methods Approach

Abstract

Background: Alarm fatigue, a multifactorial desensitization of staff to alarms, can harm both patients and health care staff in intensive care units (ICUs), especially due to false and nonactionable alarms. Increasing amounts of routinely collected alarm and ICU patient data are paving the way for training machine learning (ML) models that may help reduce the number of nonactionable alarms, potentially increasing alarm informativeness and reducing alarm fatigue. At present, however, there is no publicly available dataset or process that routinely collects information on alarm actionability (ie, whether an alarm triggers a medical intervention or not), which is a key feature for developing meaningful ML models for alarm management. Furthermore, case-based manual annotation is too slow and resource intensive for large amounts of data.

Objective: We propose a scalable method to annotate patient monitoring alarms associated with patient-related variables regarding their actionability. While the method is aimed to be used primarily in our institution, other clinicians, scientists, and industry stakeholders could reuse it to build their own datasets.

Methods: The interdisciplinary research team followed a mixed methods approach to develop the annotation method, using data-driven, qualitative, and empirical strategies. The iterative process consisted of six steps: (1) defining alarm terms; (2) reaching a consensus on an annotation concept and documentation structure; (3) defining physiological alarm conditions, related medical interventions, and time windows to assess; (4) developing mapping tables; (5) creating the annotation rule set; and (6) evaluating the generated content. All decisions were made based on feasibility criteria, clinical relevance, occurrence frequency, data availability and quantity, structure, and storage mode. The annotation guideline development process was preceded by the analysis of the institution's data and systems, the evaluation of device manuals, and a systematic literature review.

Results: In a multidisciplinary consensus-based approach, we defined preprocessing steps and a rule-based annotation method to classify alarms as either actionable or nonactionable based on data from the patient data management system. We have presented our experience in developing the annotation method and provided the generated resources. The method focuses on respiratory and medication management interventions and includes 8 general rules in a tabular format that are accompanied by graphical examples. Mapping tables enable handling unstructured information and are referenced in the annotation rule set.

Conclusions: Our annotation method will enable a large number of alarms to be labeled semiautomatically, retrospectively, and quickly, and will provide information on their actionability based on further patient data. This will make it possible to generate annotated datasets for ML models in alarm management and alarm fatigue research. We believe that our annotation method and the resources provided are universal enough and could be used by others to prepare data for future ML projects, even beyond the topic of alarms.

Keywords: alarm fatigue; alarm informativeness; alarm management; dataset annotation; digital health; intensive care unit; machine learning; patient monitoring; patient-centered care; technological innovation; transdisciplinary research.