Data for: Assessing Causes of Alarm Fatigue in Long-Term Acute Care and Its Impact on Identifying Clinical Changes in Patient Conditions

Physiologic alarms are an important modality in the care of critically ill patients. Yet the many electronic devices used in patient care and the combination of alarms can cause sensory overload in caregivers. This sensory overload can lead to monitor fatigue, and caregivers may miss critical alarms, which can be fatal for patients. Many factors not related to a change in patients’ condition can be directly linked to desensitization and alarm fatigue, leading to a failure to recognize or attend to true instability in spite of the alarm. Research demonstrates that the majority of alarms are non-actionable, and staff can develop alarm fatigue trying to determine which alarms are valid and which are not (Hravnak et al., 2018). We postulate that more experience detecting false alarms among professionals in a long-term acute care unit will lead to improved clinical changes and better survival rates among patients. Our proportional hazards model relates missing clinical changes in patients’ condition as time passes, after reduced attention to false alarms, to professional experience. In our proportional hazards model, the unique effect of a unit increase in a covariate is multiplicative with respect to the hazard rate. Therefore, reduced attention to false alarms by experienced professionals decreases the hazard rate for missing a clinical change. We use survival analyses, the hazard function, the receiver-operating characteristic curve, and the Hosmer-Lemeshow test to support our conclusions. Our results show that monitoring equipment is instrumental in alerting staff in a long-term care unit to serious changes in patients’ condition and in preventing false positives and false negatives.生理警报（physiologic alarms）是重症患者临床护理中的关键手段。但临床护理中使用的各类电子医疗设备与叠加的各类警报信号，极易引发护理人员的感官过载，进而导致监护疲劳，使护理人员可能遗漏关键警报，这对患者而言可能造成致命后果。诸多与患者病情变化无关的因素，可直接引发医护人员的警觉脱敏与警报疲劳，致使即便警报触发，医护人员也无法识别或重视患者真正的病情不稳定状况。研究表明，绝大多数警报均无临床处置意义，医护人员需耗费大量精力甄别有效与无效警报，进而产生警报疲劳（Hravnak等，2018）。我们提出研究假设：长期急性护理单元（long-term acute care unit）的专业人员若积累更多识别虚假警报的经验，将有助于优化临床处置效果，提升患者的生存率。我们构建的比例风险模型（proportional hazards model）将随时间推移未能察觉患者病情变化的情况，与护理人员对虚假警报的注意力衰减程度及从业经验相关联。在该比例风险模型中，协变量每增加1个单位，其对风险率的影响呈乘积效应。因此，经验丰富的护理人员因对虚假警报的关注度降低，可有效降低遗漏患者病情变化的风险率。本研究采用生存分析、风险函数、受试者工作特征曲线（receiver-operating characteristic curve，简称ROC曲线）以及Hosmer-Lemeshow检验来支撑研究结论。研究结果表明，监护设备可有效协助长期护理单元的医护人员及时察觉患者的严重病情变化，并减少假阳性与假阴性警报的发生。