Computer Assisted Patient Monitoring: Associated Patient, Clinical and ECG Characteristics and Strategy to Minimize False Alarms

Hearts ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 459-471
Author(s):  
Michele M. Pelter ◽  
David Mortara ◽  
Fabio Badilini
Keyword(s):  
Patient Monitoring ◽  
False Alarms ◽  
Computer Assisted ◽  
Common Source ◽  
Safety Hazard ◽  
Alarm Fatigue ◽  
School Of Nursing ◽  
The Past ◽  
Lethal Arrhythmia ◽  
Primary Problem

This chapter is a review of studies that have examined false arrhythmia alarms during in-hospital electrocardiographic (ECG) monitoring in the intensive care unit. In addition, we describe an annotation effort being conducted at the UCSF School of Nursing, Center for Physiologic Research designed to improve algorithms for lethal arrhythmias (i.e., asystole, ventricular fibrillation, and ventricular tachycardia). Background: Alarm fatigue is a serious patient safety hazard among hospitalized patients. Data from the past five years, showed that alarm fatigue was responsible for over 650 deaths, which is likely lower than the actual number due to under-reporting. Arrhythmia alarms are a common source of false alarms and 90% are false. While clinical scientists have implemented a number of interventions to reduce these types of alarms (e.g., customized alarm settings; daily skin electrode changes; disposable vs. non-disposable lead wires; and education), only minor improvements have been made. This is likely as these interventions do not address the primary problem of false arrhythmia alarms, namely deficient and outdated arrhythmia algorithms. In this chapter we will describe a number of ECG features associated with false arrhythmia alarms. In addition, we briefly discuss an annotation effort our group has undertaken to improve lethal arrhythmia algorithms.

Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue

2016 ◽  
Vol 10 (4) ◽  
pp. 91-104 ◽  
Author(s):  
Leo Kobayashi ◽  
John W. Gosbee ◽  
Derek L. Merck
Keyword(s):  
Human Factors ◽  
Patient Monitoring ◽  
Patient Simulation ◽  
False Alarms ◽  
Human Factors Engineering ◽  
Alarm Fatigue ◽  
Simulation Methodology ◽  
Institutional Review ◽  
Objective Metrics ◽  
Alerting System

Objectives: (1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification. Background: Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue. Method: Simulation, HFE, and computer science experts created a novel simulation methodology to study alarm fatigue. Featuring multiple interconnected simulated patient scenarios with scripted timeline, “distractor” patient care tasks, and triggered true and false alarms, the methodology incorporated objective metrics to assess provider and system performance. Developed materials were implemented during institutional review board–approved study sessions that assessed and compared an experimental multiparametric alerting system with a standard monitor telemetry system for subject response, use characteristics, and end-user feedback. Results: A four-patient simulation setup featuring objective metrics for participant task-related performance and response to alarms was developed along with accompanying structured HFE assessment (questionnaire and interview) for monitor systems use testing. Two pilot and four study sessions with individual nurse subjects elicited true alarm and false alarm responses (including diversion from assigned tasks) as well as nonresponses to true alarms. In-simulation observation and subject questionnaires were used to test the experimental system’s approach to suppressing false alarms and alerting providers. Conclusions: A novel investigative methodology applied simulation and HFE techniques to replicate and study alarm fatigue in controlled settings for systems assessment and experimental research purposes.

scholarly journals Significant increase in quantity and quality of knee arthroplasty related research in KSSTA over the past 15 years

2021 ◽  
Author(s):  
Stephanie Kirschbaum ◽  
Thilo Kakzhad ◽  
Fabian Granrath ◽  
Andrzej Jasina ◽  
Jakub Oronowicz ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Special Topic ◽  
Computer Assisted ◽  
Time Interval ◽  
Search Term ◽  
Level Of Evidence ◽  
The Past ◽  
Patient Reported ◽  
Over Time ◽  
Number Of Authors

Abstract Purpose This study aimed to evaluate both publication and authorship characteristics in Knee Surgery, Sports Traumatology, Arthroscopy journal (KSSTA) regarding knee arthroplasty over the past 15 years. Methods PubMed was searched for articles published in KSSTA between January 1, 2006, and December 31st, 2020, utilising the search term ‘knee arthroplasty’. 1288 articles met the inclusion criteria. The articles were evaluated using the following criteria: type of article, type of study, main topic and special topic, use of patient-reported outcome scores, number of references and citations, level of evidence (LOE), number of authors, gender of the first author and continent of origin. Three time intervals were compared: 2006–2010, 2011–2015 and 2016–2020. Results Between 2016 and 2020, publications peaked at 670 articles (52%) compared with 465 (36%) published between 2011 and 2016 and 153 articles (12%) between 2006 and 2010. While percentage of reviews (2006–2010: 0% vs. 2011–2015: 5% vs. 2016–2020: 5%) and meta-analyses (1% vs. 6% vs. 5%) increased, fewer case reports were published (13% vs. 3% vs. 1%) (p < 0.001). Interest in navigation and computer-assisted surgery decreased, whereas interest in perioperative management, robotic and individualized surgery increased over time (p < 0.001). There was an increasing number of references [26 (2–73) vs. 30 (2–158) vs. 31 (1–143), p < 0.001] while number of citations decreased [30 (0–188) vs. 22 (0–264) vs. 6 (0–106), p < 0.001]. LOE showed no significant changes (p = 0.439). The number of authors increased between each time interval (p < 0.001), while the percentage of female authors was comparable between first and last interval (p = 0.252). Europe published significantly fewer articles over time (56% vs. 47% vs. 52%), whereas the number of articles from Asia increased (35% vs. 45% vs. 37%, p = 0.005). Conclusion Increasing interest in the field of knee arthroplasty-related surgery arose within the last 15 years in KSSTA. The investigated topics showed a significant trend towards the latest techniques at each time interval. With rising number of authors, the part of female first authors also increased—but not significantly. Furthermore, publishing characteristics showed an increasing number of publications from Asia and a slightly decreasing number in Europe. Level of evidence IV.

Dynamic Alarm Systems for Hospitals (D.A.S.H.)

2018 ◽  
Vol 26 (4) ◽  
pp. 14-19 ◽  
Author(s):  
Jasmine M. Greer ◽  
Kendall J. Burdick ◽  
Arman R. Chowdhury ◽  
Joseph J. Schlesinger
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Improve Patient Safety ◽  
Environmental Noise ◽  
Care Quality ◽  
False Alarms ◽  
Alarm Fatigue ◽  
Alarm Systems ◽  
Physiological Information ◽  
Improve Patient

Hospital alarms today indicate urgent clinical need, but they are seldom “true.” False alarms are contributing to the ever-increasing issue of alarm fatigue, or desensitization, among doctors and nurses. Alarm fatigue is a high-priority health care concern because of its potential to compromise health care quality and inflict harm on patients. To address this concern, we have engineered Dynamic Alarm Systems for Hospitals (D.A.S.H.), a dynamic alarm system that self-regulates alarm loudness based on the environmental noise level and incorporates differentiable and learnable alarms. D.A.S.H., with its ability to adapt to environmental noise and encode nuanced physiological information, may improve patient safety and attenuate clinician alarm fatigue.

scholarly journals Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nations

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e033237 ◽  
Author(s):  
Owen Taylor ◽  
Sandrine Loubiere ◽  
Aurelie Tinland ◽  
Maria Vargas-Moniz ◽  
Freek Spinnewijn ◽  
...  
Keyword(s):  
Service Use ◽  
Linear Models ◽  
Pairwise Comparison ◽  
Response Rates ◽  
Computer Assisted ◽  
Generalised Linear Models ◽  
The Past ◽  
History Of ◽  
Nationally Representative ◽  
Difference Test

ObjectivesTo examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations.DesignA nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software.SettingThe study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden.ParticipantsEuropean adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country.Main outcome measuresHistory of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples.ResultsResponse rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p<0.0001). Time spent homeless ranged between less than a week (21%) and more than a year (18%), with high contrasts between countries (p<0.0001). Male gender, age 45–54, lower secondary education, single status, unemployment and an urban environment were all independently strongly associated with lifetime homelessness (all OR >1.5).ConclusionsThe prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in-time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services for people exposed to homelessness.

scholarly journals Living and Working in a Multisensory World: From Basic Neuroscience to the Hospital

2019 ◽  
Vol 3 (1) ◽  
pp. 2 ◽  
Author(s):  
Kendall Burdick ◽  
Madison Courtney ◽  
Mark Wallace ◽  
Sarah Baum Miller ◽  
Joseph Schlesinger
Keyword(s):  
Patient Outcomes ◽  
Music Theory ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Clinical Information ◽  
False Alarms ◽  
Alarm System ◽  
Potential Solution ◽  
Alarm Fatigue ◽  
Improve Patient

The intensive care unit (ICU) of a hospital is an environment subjected to ceaseless noise. Patient alarms contribute to the saturated auditory environment and often overwhelm healthcare providers with constant and false alarms. This may lead to alarm fatigue and prevent optimum patient care. In response, a multisensory alarm system developed with consideration for human neuroscience and basic music theory is proposed as a potential solution. The integration of auditory, visual, and other sensory output within an alarm system can be used to convey more meaningful clinical information about patient vital signs in the ICU and operating room to ultimately improve patient outcomes.

Should We Worry About Sponsorship-Induced Bias in Online Political Science Surveys?

2019 ◽  
Vol 7 (3) ◽  
pp. 209-217
Author(s):  
Thomas J. Leeper ◽  
Emily A. Thorson
Keyword(s):  
Public Attitudes ◽  
Computer Assisted ◽  
Online Surveys ◽  
Demand Characteristics ◽  
Face To Face ◽  
Attitudes And Behaviors ◽  
The Past ◽  
Survey Error ◽  
Satisficing Behavior ◽  
Open Question

AbstractPolitical scientists rely heavily on survey research to gain insights into public attitudes and behaviors. Over the past decade, survey data collection has moved away from personal face-to-face and telephone interviewing towards a model of computer-assisted self-interviewing. A hallmark of many online surveys is the prominent display of the survey’s sponsor, most often an academic institution, in the initial consent form and/or on the survey website itself. It is an open question whether these displays of academic survey sponsorship could increase total survey error. We measure the extent to which sponsorship (by a university or marketing firm) affects data quality, including satisficing behavior, demand characteristics, and socially desirable responding. In addition, we examine whether sponsor effects vary depending on the participant’s experience with online surveys. Overall, we find no evidence that response quality is affected by survey sponsor or by past survey experience.

Event Detection on Patient Monitoring Data Using Causal Probabilistic Networks

1994 ◽  
Vol 33 (01) ◽  
pp. 111-115 ◽  
Author(s):  
P. Laursen
Keyword(s):  
Time Use ◽  
Event Detection ◽  
Patient Monitoring ◽  
Intensive Care Patient ◽  
Care Patient ◽  
False Alarms ◽  
Probabilistic Networks ◽  
Monitoring Equipment ◽  
Number Of False Alarms ◽  
Representation Technique

Abstract:Applications are described of the knowledge-representation technique Causal Probabilistic Networks for the detection of events related to the patient and the monitoring equipment, in the context of intensive care patient monitoring. The purpose of the event detection is to reduce the number of false alarms generated by the patient monitor, and to generate alarms related to patient or equipment events rather than to threshold violation. A PC-based system has been developed and tested on patient data. A system for real-time use in patient monitoring is under development.

scholarly journals Computer- and Robot-Assisted Therapies to Aid Social and Intellectual Functioning of Children with Autism Spectrum Disorder

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 440 ◽  
Author(s):  
Joan DiPietro ◽  
Arpad Kelemen ◽  
Yulan Liang ◽  
Cecilia Sik-Lanyi
Keyword(s):  
Autism Spectrum Disorder ◽  
Social Skills ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Computer Assisted ◽  
Robot Assisted ◽  
The Past ◽  
Children With Asd ◽  
The Social

Background and objectives: Children with autism spectrum disorder (ASD) experience challenges with social interactions, a core feature of the disorder. Social skills therapy has been shown to be helpful. Over the past several years, computer-assisted and robot-assisted therapies have been infiltrating the social skills teaching environment. Rapid progress in the field of technology, especially in the robotics area, offers tremendous possibilities for innovation and treatment or even education for individuals with ASD. This paper’s purpose is to drive awareness of these innovative interventions in order to support the social lives of children with ASD. The aims of the paper are identifying (1) the types of Information Technology platforms that are being evaluated in computer and robot-assisted therapies for children with ASD; (2) the various disciplines or professions studying and utilizing these computer and robot-assisted social skill therapies; (3) the outcomes being evaluated in each trial; and (4) if results demonstrate benefits to children with autism. Materials and Methods: PubMed, CINAHL, Science Direct, and Web of Science databases were searched for clinical trials published over the past five years. Search terms incorporated the subject intersection of autism, and computer or robot-assisted therapy. Results were mined for pediatric populations only and study designs establishing controlled comparisons. Results: Eighteen unique international studies were identified that utilize robot interventions (11 studies) and serious computer game interventions (seven studies). Most demonstrated promising results in improving outcomes for children with ASD. Study implications reveal a rapidly evolving assistive technology for ASD social skills therapy. Conclusions: These interventions show considerable promise, but more effectiveness and cost effectiveness research of high quality should be carried out with larger numbers of children. Also, further studies are necessary to evaluate these technologies’ effectiveness amongst adults with ASD and within unique subsets of the higher functioning autism population.

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