Alarms

Alarming Data from the Intensive Cardiac Care Unit

JA Lipton, MJB van Ettinger, RJ Barendse, TB van Dam, NHJJ van der Putten, SP Nelwan

Patients admitted in the Intensive Cardiac Care Unit (ICCU) are closely monitored by different devices. When an abnormal signal is detected, an alarm is generated, however most alarms do not signify a life-threatening event (approximately 5% of the alarms require clinical action). The distribution of alarms over time and by type of device is not well known. During a four month period all alarms from the 8-bed ICCU at the ErasmusMC were collected in a database. The alarms were categorized by type, hour and day of week. During the four month period 34827 alarms were collected during 547 admissions with a median(IQR) duration of 6.1(3-23) hours. On average there were 2.2 alerts per patient per hour. The goal was to develop insight into the frequency and type of alarms to develop an intellegent alarm management system. This will be presented at Computers in Cardiology 2009; a manuscript is available as well.

An Open Source Toolkit for Managing Patient Monitoring Device Alarms Based on the IHE Alarm Communication Management Profile

MJB van Ettinger, JA Lipton, KJ Fuchs, TB van Dam, RJ Barendse, NHJJ van der Putten, SP Nelwan

The “ Integrating the Healthcare Enterprise” (IHE) initiative organized by healthcare professionals and industry has defined an Alarm Communication Management (ACM) profile as part of the Patient Care Device (PCD) domain in order to communicate alarms from patient monitoring and therapeutic devices in a consistent way. The ACM profile may lead to interoperability between systems of different manufacturers and may result in allowing alarm messages to be communicated in a standardized way. We have implemented an extensible, open source framework (C#, ASP.NET) based on the ACM 2008 standard and interfaced our patient monitoring equipment (Draeger Medical), and infusion pumps (Alaris) using several export interfaces (RSS, ESPA, XMPP, SMS, SNPP) available in the intensive care units of the Erasmus MC. The framework can be extended by plug ins for devices that generate alarms and those that display alarms. Alarms can be archived to a SQL server database. The open source framework is available on http://i-put.sourceforge.net. The framework enables new applications which may improve the accuracy of the alarms. Patient monitoring and therapeutic devices at the bedside generate many audible and visual alarms which interrupt care as they require a clinician to review each alarm. Few of the alarms actually represent life threatening events; most result from (slightly) abnormal values or artifacts. These alarms are often presented on different screens, use different sounds and visual effects. Also, to change specific alarm settings, each device needs to be configured separately. Finally, devices do not exchange alarm information with other devices of the same patient, so each device will generate its own stream of alarms. Thus, a single physiological event may trigger different alarms (time, message and/or level) for each attached device. Using the ACM profile can lead to systems which improve the frequency and presentation, as well as the accuracy of these alarms. In conclusion, the presented open source framework of the IHE PCD ACM profile provides a starting point for a centralized, uniformed approach to device alarm management.This is a prerequisite for intelligent alarming. An open source solution for this was developed by our group and is available at sourceforge. This work was presented at Computers in Cardiology 2009; a manuscript is being prepared.

Multimedia paging device for alarms

MJB van Ettinger, JA Lipton, SP Nelwan, TB van Dam, NHJJ van der Putten

Patients admitted to the Critical Cardiac Care unit are closely monitored by different devices that generate alarms when an abnormality is detected. Alarms are typically displayed on the patient monitor and a central nursing post. However, caregivers are frequently not at either of these locations. Also, most alarms do not signify a life-threatening event. Delivery of patient monitoring alarms to directly to the caregiver could result in faster, more adequate reaction to the messages. To reduce overall frequency and improve accuracy, a platform for decision rules and evaluation of alarm data is required.

At the Erasmus Medical Center patient monitors of the Cardiac Critical Care units are connected to a central gateway. An application was developed, using ASP.NET 2.0, C#, Asynchronous Javascript and XML to collect and manage alarms from the gateway. The alarm manager stores the alarm messages in a SQL database; a web-interface provides access to the data. A smartphone-based platform provides a user interface and allows Multimedia Pages to be delivered directly to the caregiver. The interface can be configured to display alarms for each patient bed, or for an entire care unit and is updated every 5 seconds. By clicking on an alarm, the message and vital signs (SpO2, blood pressure and electrocardiogram) are displayed, enabling the user to make an informed decision regarding further action.

The alarm database enables evaluation of user targeted interventions to reduce alarm frequency. When combined with a rule-engine, “smart alarms” could be generated that utilize data from different monitoring devices, laboratory results and/or decision support messages.

The multimedia paging application allows delivery of alarms and clinical data directly to the caregiver on a portable electronic device, enables evaluation of alarm data and provides a platform for generating “smart” alarms.

This work is being prepared for the European Society of Cardiology meeting in 2010, and for Computers in Cardiology 2010. A demonstation version is available now; http://www.spotchecker.eu/

User interface on an i-Phone