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1.
IEEE Trans Biomed Circuits Syst ; 14(5): 1088-1096, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32870799

RESUMO

In response to anticipated shortages of ventilators caused by the COVID-19 pandemic, many organizations have designed low-cost emergency ventilators. Many of these devices are pressure-cycled pneumatic ventilators, which are easy to produce but often do not include the sensing or alarm features found on commercial ventilators. This work reports a low-cost, easy-to-produce electronic sensor and alarm system for pressure-cycled ventilators that estimates clinically useful metrics such as pressure and respiratory rate and sounds an alarm when the ventilator malfunctions. A low-complexity signal processing algorithm uses a pair of nonlinear recursive envelope trackers to monitor the signal from an electronic pressure sensor connected to the patient airway. The algorithm, inspired by those used in hearing aids, requires little memory and performs only a few calculations on each sample so that it can run on nearly any microcontroller.


Assuntos
Alarmes Clínicos , Infecções por Coronavirus/terapia , Monitorização Fisiológica/instrumentação , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Processamento de Sinais Assistido por Computador , Ventiladores Mecânicos , Algoritmos , Eletrônica , Desenho de Equipamento , Humanos , Pandemias , Respiração , Software
3.
Br J Anaesth ; 125(5): 826-834, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32682554

RESUMO

BACKGROUND: We compared anaesthetists' ability to identify haemoglobin oxygen saturation (SpO2) levels using two auditory displays: one based on a standard pulse oximeter display (varying pitch plus alarm) and the other enhanced with additional sound properties (varying pitch plus tremolo and acoustic brightness) to differentiate SpO2 ranges. METHODS: In a counter-balanced crossover study in a simulator, 20 experienced anaesthetists supervised a junior colleague (an actor) managing two airway surgery scenarios: once while using the enhanced auditory display and once while using a standard auditory display. Participants were distracted with other tasks such as paperwork and workplace interruptions, but were required to identify when SpO2 transitioned between pre-set ranges (target, low, critical) and when other vital signs transitioned out of a target range. They also identified the range once a transition had occurred. Visual displays were available for all monitored vital signs, but the numerical value for SpO2 was excluded. RESULTS: Participants were more accurate and faster at detecting transitions to and from the target SpO2 range when using the enhanced display (100.0%, 3.3 s) than when using the standard display plus alarm (73.2%, 27.4 s) (P<0.001 and P=0.004, respectively). They were also more accurate at identifying the SpO2 range once a transition had occurred when using the enhanced display (100.0%) than when using the standard display plus alarm (57.1%; P<0.001). CONCLUSIONS: The enhanced auditory display helps anaesthetists judge SpO2 levels more effectively than current auditory displays and may facilitate 'eyes-free' monitoring.


Assuntos
Apresentação de Dados , Oximetria/instrumentação , Estimulação Acústica , Adulto , Anestesiologistas , Alarmes Clínicos , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/organização & administração , Oxigênio/sangue , Inquéritos e Questionários , Sinais Vitais
4.
Emerg Med Clin North Am ; 38(3): 681-691, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616287

RESUMO

Information management in the emergency department (ED) is a challenge for all providers. The volume of information required to care for each patient and to keep the ED functioning is immense. It must be managed through varying means of communication and in connection with ED information systems. Management of information in the ED is imperfect; different modes and methods of identification, interpretation, action, and communication can be beneficial or harmful to providers, patients, and departmental flow. This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Gestão da Informação em Saúde/organização & administração , Alarmes Clínicos , Comunicação , Sistemas de Informação Hospitalar , Humanos , Sistemas de Registro de Ordens Médicas , Sistemas de Identificação de Pacientes/organização & administração , Triagem/organização & administração
5.
Rech Soins Infirm ; 140(1): 57-68, 2020 03.
Artigo em Francês | MEDLINE | ID: mdl-32524802

RESUMO

Introduction : In critical care units, improper alarm settings for bedside monitoring systems promotes numerous alarms and may lead to nurse fatigue. Purpose : Achieve an integrative review of the literature to identify the factors that influence the nurse in her decision to set and modulate the alarm parameters of bedside monitoring systems in the intensive care unit. Method : An integrative review of the literature according to the five steps of the Whittemore and Knafl method was carried out from the literature related to the field of critical care. Results : The factors related to the nurse's decision to set or modulate the alarm parameters of the monitoring systems are divided into two themes : personal factors and contextual factors. Discussion : Certain factors identified in this integrative review were also identified as elements that contribute to the clinical surveillance process carried out by expert nurses in a critical care context. Conclusion : The results of this study suggest the need to focus empirically on the factors influencing the nurse's decision to adjust and modulate alarm parameters in critical care monitoring systems.


Assuntos
Alarmes Clínicos , Enfermagem de Cuidados Críticos , Recursos Humanos de Enfermagem no Hospital/psicologia , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Unidades de Terapia Intensiva
6.
Cochrane Database Syst Rev ; 5: CD002911, 2020 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32364251

RESUMO

BACKGROUND: Enuresis (bedwetting) affects up to 20% of five-year-olds and can have considerable social, emotional and psychological effects. Treatments include alarms (activated by urination), behavioural interventions and drugs. OBJECTIVES: To assess the effects of enuresis alarms for treating enuresis in children. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 25 June 2018), and reference lists of relevant articles. SELECTION CRITERIA: We included randomised or quasi-randomised trials of enuresis alarms or alarms combined with another intervention for treating nocturnal enuresis in children between 5 and 16 years old. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data. MAIN RESULTS: We included 74 trials (5983 children). At treatment completion, alarms may reduce the number of wet nights a week compared to control or no treatment (mean difference (MD) -2.68, 95% confidence interval (CI) -4.59 to -0.78; 4 trials, 127 children; low-quality evidence). Low-quality evidence suggests more children may achieve complete response (14 consecutive dry nights) with alarms compared to control or no treatment (RR 7.23, 95% CI 1.40 to 37.33; 18 trials, 827 children) and that more children may remain dry post-treatment (RR 9.67, 95% CI 4.74 to 19.76; 10 trials, 366 children; low-quality evidence). At treatment completion, we are uncertain whether there is any difference between alarms and placebo drugs in the number of wet nights a week (MD -0.96, 95% CI -2.32 to 0.41; 1 trial, 47 children; very low-quality evidence). Alarms may result in more children achieving complete response than with placebo drugs (RR 1.59, 95% CI 1.16 to 2.17; 2 trials, 181 children; low-quality evidence). No trials comparing alarms to placebo reported the number of children remaining dry post-treatment. Compared with control alarms, code-word alarms probably slightly increase the number of children achieving complete response at treatment completion (RR 1.11, 95% CI 0.97 to 1.27; 1 trial, 353 children; moderate-quality evidence) but there is probably little to no difference in the number of children remaining dry post-treatment (RR 0.91, 95% CI 0.79 to 1.05; moderate-quality evidence). Very low-quality evidence means we are uncertain if there are any differences in effectiveness between the other different types of alarm. At treatment completion, alarms may reduce the number of wet nights a week compared with behavioural interventions (waking, bladder training, dry-bed training, and star chart plus rewards) (MD -0.81, 95% CI -2.01 to 0.38; low-quality evidence) and may increase the number of children achieving complete response (RR 1.77, 95% CI 0.98 to 3.19; low-quality evidence) and may slightly increase the number of children remaining dry post-treatment (RR 1.39, 95% CI 0.81 to 2.41; low-quality evidence). The evidence relating to alarms compared with desmopressin in the number of wet nights a week (MD -0.64, 95% CI -1.77 to 0.49; 4 trials, 285 children) and the number of children achieving complete response at treatment completion (RR 1.12, 95% CI 0.93 to 1.36; 12 trials, 1168 children) is low-quality, spanning possible harms and possible benefits. Alarms probably slightly increase the number of children remaining dry post-treatment compared with desmopressin (RR 1.30, 95% CI 0.92 to 1.84; 5 trials, 565 children; moderate-quality evidence). At treatment completion, we are uncertain if there is any difference between alarms and tricyclics in the number of wet nights a week, the number of children achieving complete response or the number of children remaining dry post-treatment, because the quality of evidence is very low. Due to very low-quality evidence we are uncertain about any differences in effectiveness between alarms and cognitive behavioural therapy, psychotherapy, hypnotherapy and restricted diet. Alarm plus desmopressin may reduce the number of wet nights a week compared with desmopressin monotherapy (MD -0.88, 95% CI -0.38 to -1.38; 2 trials, 156 children; low-quality evidence). Alarm plus desmopressin may increase the number of children achieving complete response (RR 1.32, 95% CI 1.08 to 1.62; 5 trials, 359 children; low-quality evidence) and the number of children remaining dry post-treatment (RR 2.33, 95% CI 1.26 to 4.29; 2 trials, 161 children; low-quality evidence) compared with desmopressin alone. Alarm plus dry-bed training may increase the number of children achieving a complete response compared to dry-bed training alone (RR 3.79, 95% CI 1.85 to 7.77; 1 trial, 80 children; low-quality evidence). It is unclear if there is any difference in the number of children remaining dry post-treatment because of the wide confidence interval (RR 0.56, 95% CI 0.15 to 2.12; low-quality evidence). Due to very low-quality evidence, we are uncertain about any differences in effectiveness between alarm plus bladder training versus bladder training alone. Of the 74 included trials, 17 reported one or more adverse events, nine reported no adverse events and 48 did not mention adverse events. Adverse events attributed to alarms included failure to wake the child, ringing without urination, waking others, causing discomfort, frightening the child and being too difficult to use. Adverse events of comparator interventions included nose bleeds, headaches and abdominal pain. There is probably a slight increase in adverse events between code-word alarm and standard alarm (RR 1.34, 95% CI 0.75 to 2.38; moderate-quality evidence), although we are uncertain because of the wide confidence interval. Alarms probably reduce the number of children experiencing adverse events compared with desmopressin (RR 0.38, 95% CI 0.20 to 0.71; 5 trials, 565 children; moderate-quality evidence). Very low-quality evidence means we cannot be certain whether the adverse event rate for alarms is lower than for other treatments. AUTHORS' CONCLUSIONS: Alarm therapy may be more effective than no treatment in reducing enuresis in children. We are uncertain if alarm therapy is more effective than desmopressin but there is probably a lower risk of adverse events with alarms than with desmopressin. Despite the large number of trials included in this review, further adequately-powered trials with robust randomisation are still needed to determine the full effect of alarm therapy.


Assuntos
Alarmes Clínicos , Enurese Noturna/prevenção & controle , Absorventes Higiênicos , Estudos de Casos e Controles , Criança , Pré-Escolar , Terapia Combinada/métodos , Desamino Arginina Vasopressina/uso terapêutico , Humanos , Nefrologia/métodos , Enurese Noturna/tratamento farmacológico , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fármacos Renais/uso terapêutico , Resultado do Tratamento
7.
Intensive Crit Care Nurs ; 59: 102845, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32238311

RESUMO

OBJECTIVE: The present study aimed to determine the types of monitor alarms and nurses' responses to them in an adult intensive care unit. DESIGN AND METHODS: This was an observational descriptive research study conducted in the adult intensive care unit of a university hospital in the Mediterranean region of Turkey. The nonparticipant observation method was used. Data were collected by two observers using a semi-structured observation form developed according to literature. RESULTS: Between August 2016 and January 2017, 13 registered nurses were observed for 328 hours. There were 1781 alarms, which included alarms for blood pressure (37.6%), respiration and oxygen saturation (35.3%) and heart rate and arrhythmia (27.1%). Nurses responded to approximately half (46.9%) of the alarms that required a response. Responses to alarms included silencing them, responding to the patient's clinical condition and solving contact and transmission problems. CONCLUSION: In the present study, according to response requirement, the division of the alarms was different. The number of alarms that do not reflect the clinical status of the patient was high. It was found that as the false alarm rate increased, the response rate of nurses to these alarms decreased.


Assuntos
Alarmes Clínicos/efeitos adversos , Enfermeiras e Enfermeiros/psicologia , Adulto , Distribuição de Qui-Quadrado , Alarmes Clínicos/normas , Alarmes Clínicos/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Estatísticas não Paramétricas , Inquéritos e Questionários , Turquia
8.
Sensors (Basel) ; 20(3)2020 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-32024244

RESUMO

Proximity warning systems for construction sites do not consider whether workers are already aware of the hazard prior to issuing warnings. This can generate redundant and distracting alarms that interfere with worker ability to adopt timely and appropriate avoidance measures; and cause alarm fatigue, which instigates workers to habitually disable the system or ignore the alarms; thereby increasing the risk of injury. Thus, this paper integrates the field-of-view of workers as a proxy for hazard awareness to develop an improved hazard proximity warning system for construction sites. The research first developed a rule-based model for the warning generation, which was followed by a virtual experiment to evaluate the integration of worker field-of-view in alarm generation. Based on these findings, an improved hazard proximity warning system incorporating worker field-of-view was developed for field applications that utilizes wearable inertial measurement units and localization sensors. The system's effectiveness is illustrated through several case studies. This research provides a fresh perspective to the growing adoption of wearable sensors by incorporating the awareness of workers into the generation of hazard alarms. The proposed system is anticipated to reduce unnecessary and distracting alarms which can potentially lead to superior safety performance in construction.


Assuntos
Alarmes Clínicos/tendências , Indústria da Construção/tendências , Gestão da Segurança/métodos , Ferimentos e Lesões/epidemiologia , Humanos , Local de Trabalho
9.
Drug Ther Bull ; 58(2): 25-29, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32001450

RESUMO

Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.


Assuntos
Alarmes Clínicos , Desamino Arginina Vasopressina/uso terapêutico , Enurese Noturna/tratamento farmacológico , Fatores Etários , Antidepressivos Tricíclicos/uso terapêutico , Comorbidade , Humanos , Antagonistas Muscarínicos/uso terapêutico , Enurese Noturna/terapia
10.
Clin Nurse Spec ; 34(2): 50-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32068633

RESUMO

Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.


Assuntos
Alarmes Clínicos , Monitorização Fisiológica/enfermagem , Recursos Humanos de Enfermagem/educação , Gestão da Segurança/organização & administração , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem
11.
Pediatr Emerg Care ; 36(2): 63-65, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929394

RESUMO

OBJECTIVES: To compare timeliness of sepsis recognition and initial treatment in patients with and without high-risk comorbid conditions. METHODS: This was a retrospective cohort study of patients presenting to a pediatric emergency department (ED) who triggered a vital sign-based electronic sepsis alert resulting in bedside "huddle" assessment per institutional practice. A positive sepsis alert was defined as age-specific tachycardia or hypotension, concern for infection, and at least 1 of the following: abnormal capillary refill, abnormal mental status, or a high-risk condition. High-risk conditions were derived from the American Academy of Pediatrics sepsis alert tool. Patients with a positive alert underwent bedside huddle resulting in a decision regarding initiation of sepsis protocol. Placement on the protocol and time to initiation of protocol and individual therapies were compared for patients with and without high-risk conditions. RESULTS: During the 1-year study period, there were 1107 sepsis huddle alerts out of 96,427 ED visits. Of these, 713 (65%) had identified high-risk conditions, and 394 (35%) did not. Among patients with sepsis huddles, there was no difference in sepsis protocol initiation for patients with high-risk conditions compared with those without (24.8% vs 22.0%, P = 0.305). Between patients with high-risk conditions and those without, there were no differences in median time from triage to sepsis protocol activation, triage to initial intravenous antibiotic, triage to initial intravenous fluid therapy, or ED length of stay. CONCLUSIONS: Timeliness of care initiation was no different in high-risk patients with sepsis when using an electronic sepsis alert and protocolized sepsis care.


Assuntos
Serviço Hospitalar de Emergência , Sepse/diagnóstico , Sepse/terapia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Alarmes Clínicos , Comorbidade , Feminino , Hidratação , Humanos , Hipotensão/epidemiologia , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Medicina de Emergência Pediátrica , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Tempo para o Tratamento , Triagem , Sinais Vitais
14.
PLoS One ; 15(1): e0226990, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923226

RESUMO

This study proposes a deep learning model that effectively suppresses the false alarms in the intensive care units (ICUs) without ignoring the true alarms using single- and multi- modal biosignals. Most of the current work in the literature are either rule-based methods, requiring prior knowledge of arrhythmia analysis to build rules, or classical machine learning approaches, depending on hand-engineered features. In this work, we apply convolutional neural networks to automatically extract time-invariant features, an attention mechanism to put more emphasis on the important regions of the segmented input signal(s) that are more likely to contribute to an alarm, and long short-term memory units to capture the temporal information presented in the signal segments. We trained our method efficiently using a two-step training algorithm (i.e., pre-training and fine-tuning the proposed network) on the dataset provided by the PhysioNet computing in cardiology challenge 2015. The evaluation results demonstrate that the proposed method obtains better results compared to other existing algorithms for the false alarm reduction task in ICUs. The proposed method achieves a sensitivity of 93.88% and a specificity of 92.05% for the alarm classification, considering three different signals. In addition, our experiments for 5 separate alarm types leads significant results, where we just consider a single-lead ECG (e.g., a sensitivity of 90.71%, a specificity of 88.30%, an AUC of 89.51 for alarm type of Ventricular Tachycardia arrhythmia).


Assuntos
Arritmias Cardíacas/diagnóstico , Alarmes Clínicos/normas , Monitorização Fisiológica/métodos , Redes Neurais de Computação , Aprendizado de Máquina Supervisionado/normas , Algoritmos , Reações Falso-Positivas , Humanos , Unidades de Terapia Intensiva , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Sensibilidade e Especificidade
15.
Lancet Gastroenterol Hepatol ; 5(4): 343-351, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31981517

RESUMO

BACKGROUND: Colonoscopy with computer-aided detection (CADe) has been shown in non-blinded trials to improve detection of colon polyps and adenomas by providing visual alarms during the procedure. We aimed to assess the effectiveness of a CADe system that avoids potential operational bias. METHODS: We did a double-blind randomised trial at the endoscopy centre in Caotang branch hospital of Sichuan Provincial People's Hospital in China. We enrolled consecutive patients (aged 18-75 years) presenting for diagnostic and screening colonoscopy. We excluded patients with a history of inflammatory bowel disease, colorectal cancer, or colorectal surgery or who had a contraindication for biopsy; we also excluded patients who had previously had an unsuccessful colonoscopy and who had a high suspicion for polyposis syndromes, inflammatory bowel disease, and colorectal cancer. We allocated patients (1:1) to colonoscopy with either the CADe system or a sham system. Randomisation was by computer-generated random number allocation. Patients and the endoscopist were unaware of the random assignment. To achieve masking, the output of the system was shown on a second monitor that was only visible to an observer who was responsible for reporting the alerts. The primary outcome was the adenoma detection rate (ADR), which is the proportion of individuals having a complete colonoscopy, from caecum to rectum, who had one or more adenomas detected. The primary analysis was per protocol. We also analysed characteristics of polyps and adenomas missed initially by endoscopists but detected by the CADe system. This trial is complete and is registered with http://www.chictr.org.cn, ChiCTR1800017675. FINDINGS: Between Sept 3, 2018, and Jan 11, 2019, 1046 patients were enrolled to the study, of whom 36 were excluded before randomisation, 508 were allocated colonoscopy with polyp detection using the CADe system, and 502 were allocated colonoscopy with the sham system. After further excluding patients who met exclusion criteria, 484 patients in the CADe group and 478 in the sham group were included in analyses. The ADR was significantly greater in the CADe group than in the sham group, with 165 (34%) of 484 patients allocated to the CADe system having one or more adenomas detected versus 132 (28%) of 478 allocated to the sham system (odds ratio 1·36, 95% CI 1·03-1·79; p=0·030). No complications were reported among all colonoscopy procedures. Polyps initially missed by the endoscopist but identified by the CADe system were generally small in size, isochromatic, flat in shape, had an unclear boundary, were partly behind colon folds, and were on the edge of the visual field. INTERPRETATION: Polyps initially missed by the endoscopist had characteristics that are sometimes difficult for skilled endoscopists to recognise. Such polyps could be detected using a high-performance CADe system during colonoscopy. The effect of CADe during colonoscopy on the incidence of interval colorectal cancer should be investigated. FUNDING: None.


Assuntos
Adenoma/diagnóstico por imagem , Pólipos do Colo/patologia , Colonoscopia/instrumentação , Aprendizado Profundo/normas , Diagnóstico por Computador/instrumentação , Adulto , Estudos de Casos e Controles , China/epidemiologia , Alarmes Clínicos/normas , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Aprendizado Profundo/estatística & dados numéricos , Método Duplo-Cego , Diagnóstico Precoce , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Variações Dependentes do Observador
16.
Circ Cardiovasc Interv ; 13(1): e008290, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31884835

RESUMO

BACKGROUND: The clinical utility of routine electrocardiographic monitoring following percutaneous coronary interventions (PCI) is not well studied. METHODS: We prospectively evaluated the incidence, cost, and the clinical implications of actionable arrhythmia alarms on telemetry monitoring following PCI. One thousand three hundred fifty-eight PCI procedures (989 [72.8%] for acute coronary syndrome and 369 [27.2%] for stable angina) on patients admitted to nonintensive care unit were identified and divided into 2 groups; group 1, patients with actionable alarms (AA) and group 2, patients with non-AA. AA included (1) ≥3 s electrical pause or asystole; (2) high-grade Mobitz type II atrioventricular block or complete heart block; (3) ventricular fibrillation; (4) ventricular tachycardia (>15 beats); (5) atrial fibrillation with rapid ventricular response; (6) supraventricular tachycardia (>15 beats). Primary outcomes were 30-day all-cause mortality. Cost-savings analysis was performed. RESULTS: Incidence of AA was 2.2% (37/1672). Time from end of procedure to AA was 5.5 (0.5, 24.5) hours. Patients with AA were older, presented with acute congestive heart failure or non-ST-segment-elevation myocardial infarction, and had multivessel or left main disease. The 30-day all-cause mortality was significantly higher in patients with AA (6.5% versus 0.3% in non-AA [P<0.001]). Applying the standardized costing approach and tailored monitoring per the American Heart Association guidelines lead to potential cost savings of $622 480.95 for the entire population. CONCLUSIONS: AA following PCI were infrequent but were associated with increase in 30-day mortality. Following American Heart Association guidelines for monitoring after PCI can lead to substantial cost saving.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial , Frequência Cardíaca , Intervenção Coronária Percutânea/efeitos adversos , Telemetria , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/economia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Alarmes Clínicos , Redução de Custos , Análise Custo-Benefício , Eletrocardiografia Ambulatorial/economia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Telemetria/economia , Telemetria/instrumentação , Fatores de Tempo , Resultado do Tratamento
17.
Healthc Manage Forum ; 33(1): 30-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31802724

RESUMO

Hospitals are facing an unprecedented level of change-with pressure from the general public to provide high-quality care and retain top talent by preventing burnout. How can they provide better patient care without overwhelming clinicians with more connected devices, alarming systems, and analytics solutions? Some challenges do not just cause harm to patients but they have a major economic impact on the financial health of the hospital. One problem for many hospitals is the growing number of "code blue" calls that warn clinicians a patient is in cardiac arrest. In this case study, you will learn the impacts of introducing an early warning system and its enabling technologies on Hamilton Health Sciences and why the underlying technology helped to produce positive results.


Assuntos
Reanimação Cardiopulmonar/métodos , Alarmes Clínicos , Tecnologia Biomédica , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/estatística & dados numéricos , Escore de Alerta Precoce , Humanos
18.
Ergonomics ; 62(12): 1617-1629, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587607

RESUMO

Identifiability and perceived urgency were compared for two sets of alarms in a healthcare inpatient setting. One contained currently used alarms where possible, with new sounds added as needed. The other was designed together, was more heterogenous, used timbre to encode intended similarities and explicitly encoded intended urgency across the set. Twenty nurses reported the identity and perceived urgency of the sounds in each set. Participants correctly identified the sound (0.89 vs. 0.77) and alarm category (0.93 vs. 0.82) more often in the new set than in the baseline set. In addition, multiple sounds in the new set were more identifiable. The new sounds also had a larger range of perceived urgency and better urgency match. The results indicate that timbre is well-suited to encode alarm groupings in larger alarm sets and that this, along with increased heterogeneity and explicit urgency mapping, improves alarm set performance. Practitioner summary: Clinical alarms are frequently misidentified. We found that making alarms more acoustically rich, using timbre to convey alarm groups, and explicitly encoding intended urgency improved identifiability and urgency match. These findings can be used to improve alarm performance across all safety-critical industries.


Assuntos
Acústica , Percepção Auditiva , Alarmes Clínicos , Emergências , Som , Adulto , Desenho de Equipamento , Ergonomia , Humanos , Pessoa de Meia-Idade
20.
Stud Health Technol Inform ; 267: 273-281, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483282

RESUMO

Excessive numbers of clinical alarms reduce the awareness of caregivers. Frequent alarms, many of which are non-actionable, can lead to cognitive overload, stress, and desensitization to alarms, called "Alarm Fatigue", which can severely impact patient safety. Due to the multifactorial nature of excessive alarming quantitative data about many facets of alarm generation and management are required in order to tackle the problem efficiently and effectively. Since there is no system available which would provide said data, we set out to develop one in the form of a data warehouse based on a thorough understanding of clinicians' needs. The developed system answers the users' needs in terms of readily providing them information on a daily basis, but also serves as a data source for further research. Further work is needed to include alarm sources from outside the patient monitoring infrastructure.


Assuntos
Alarmes Clínicos , Fadiga , Humanos , Unidades de Terapia Intensiva , Monitorização Fisiológica , Segurança do Paciente
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