Data from: The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study

Objectives: To determine (1) the proportion and number of clinically relevant alarms based on the type of monitoring device; (2) whether patient clinical severity, based on the sequential organ failure assessment (SOFA) score, affects the proportion of clinically relevant alarms and to suggest; (3) methods for reducing clinically irrelevant alarms in an intensive care unit (ICU). Design: A prospective, observational clinical study. Setting: A medical ICU at the University of Tokyo Hospital in Tokyo, Japan. Participants: All patients who were admitted directly to the ICU, aged ≥18 years, and not refused active treatment were registered between January and February 2012. Methods: The alarms, alarm settings, alarm messages, waveforms and video recordings were acquired in real time and saved continuously. All alarms were annotated with respect to technical and clinical validity. Results: 18 ICU patients were monitored. During 2697 patient-monitored hours, 11 591 alarms were annotated. Only 740 (6.4%) alarms were considered to be clinically relevant. The monitoring devices that triggered alarms the most often were the direct measurement of arterial pressure (33.5%), oxygen saturation (24.2%), and electrocardiogram (22.9%). The numbers of relevant alarms were 12.4% (direct measurement of arterial pressure), 2.4% (oxygen saturation) and 5.3% (electrocardiogram). Positive correlations were established between patient clinical severities and the proportion of relevant alarms. The total number of irrelevant alarms could be reduced by 21.4% by evaluating their technical relevance. Conclusions: We demonstrated that (1) the types of devices that alarm the most frequently were direct measurements of arterial pressure, oxygen saturation and ECG, and most of those alarms were not clinically relevant; (2) the proportion of clinically relevant alarms decreased as the patients’ status improved and (3) the irrelevance alarms can be considerably reduced by evaluating their technical relevance.

研究目标：明确(1) 基于监护设备类型划分的临床相关性警报的占比与数量；(2) 基于序贯器官衰竭评分（Sequential Organ Failure Assessment, SOFA）评估的患者临床严重程度是否会影响临床相关性警报的占比；同时提出(3) 重症监护病房（Intensive Care Unit, ICU）内减少临床非相关性警报的可行方法。

研究设计：前瞻性观察性临床研究。

研究场景：日本东京大学医院内科重症监护病房。

研究对象：2012年1月至2月期间，直接收入ICU、年龄≥18岁且未拒绝积极治疗的所有患者。

研究方法：实时采集警报信息、警报设置参数、警报报文、波形数据与视频录像并持续存储；对所有警报的技术有效性与临床有效性进行标注。

研究结果：本研究共纳入18例ICU患者进行监护。在总计2697小时的患者监护时长内，共标注11591条警报，其中仅740条（6.4%）被判定为临床相关性警报。触发警报频次最高的监护设备依次为有创动脉压监测设备（33.5%）、血氧饱和度监测设备（24.2%）与心电图（Electrocardiogram, ECG）监测设备（22.9%）；上述设备对应的临床相关性警报占比分别为12.4%（有创动脉压监测）、2.4%（血氧饱和度监测）与5.3%（心电图监测）。患者临床严重程度与临床相关性警报占比呈正相关。通过评估警报的技术有效性，可使非相关性警报总数量降低21.4%。

研究结论：本研究证实(1) 警报触发频次最高的监护设备为有创动脉压、血氧饱和度与心电图监测设备，且其中绝大多数警报不具备临床相关性；(2) 临床相关性警报占比随患者病情改善而降低；(3) 通过评估警报的技术有效性，可显著减少非相关性警报的总量。