it's not about the alarms! -...

keeping an eye on life.

Surveillance Monitoring System

It’s not about the alarms!

25-75% ofadverse eventsand preventabledeaths occuroutside of the ICU in unmonitored beds1

•  Up to 60% of non-ICU beds are unmonitored2

•  84% of patients exhibit signs of deterioration within 8 hours preceding cardio-pulmonary arrest3

1  http://www.ihi.org/education/conferences/APACForum2012/Documents/I2_Presentation_Diagnostics_Haraden.pdf

2  AHA database, 2013 3  Schein RM et al. Clinical antecedents to in-hospital cardiopulmonary arrest.

Chest 1990;98:1388-92.

•  Approximately  5%  of  hospital  admissions  have  an  unexpected  transfer  to  the  ICU*  

•  For  every  1  hour  increase  in  transfer  delay,  the  odds  of  an  in-­‐hospital  death  increased  3%    

•  For  pa?ents  who  survived  un?l  discharge,  delayed  transfer  was  associated  with  a  longer  length  of  stay.  

Wendlandt, B et al. Association between ICU Transfer Delay and Hospital Mortality: A Multicenter Investigation (abstract). Journal or Hospital Medicine 2015:10 (suppl 2).

*Churpek,M et all. Multicenter Development and Validation Tool for Ward Patients. American Journal of Respiratory and Critical Care Medicine. Vol 190 No 6. Sept 15, 2014

Rapid Response Systems

ICU  

General  Floor  

Professor  Kenneth  Hillman,  AO  

Conditional versus Surveillance Monitoring

Condi6onal  Monitoring  (ICU)  

•  Pa?ent  has  risk  factors  

•  Monitoring  as  ordered  

•  Specialized  monitoring  

•  Targeted  measures  (cardiac  telemetry  for  cardiac  pa?ents)  

•  High-­‐risk  popula?on  

•  Special  wards  

Surveillance  Monitoring  (General  Floor)  

•  Environment  has  risk  factors  

•  Monitoring  as  standard  of  care  

•  General  monitoring  

•  Mul?-­‐parameter  measurements  (HR,  RR,  BP,  SpO2,  etc)  

•  Lower-­‐risk  popula?on  

•  General  care  wards  

Optimizing Alarms for Surveillance Monitoring

Objectives: 1.  Detect patient deterioration 2.  Alarm only on clinically actionable events

•  Requires beside intervention •  Reverses an emerging harmful event

3.  Build large data base •  Optimize alarm configuration settings •  Develop strategies to reduce false alarms •  Develop new “smart” alarm algorithms

Optimizing Alarms for Surveillance Monitoring Methods: 1.  Capture high fidelity physiologic data in

intended application across multiple hospitals •  Capture and store data at the hospital •  De-identify PHI •  Transfer and store data in cloud

repository 2.  Characterize distribution of each vital sign

under actual clinical use 3.  Perform “what if” analysis across multiple

alarm configurations •  Optimize threshold settings •  Optimize alarm delays

275,000  hours  of  pa?ent  data  

Predictive Analytics Alarm  Configura6on  

Alarm  Performance  De-­‐iden?fy  PHI  

Distribution of SpO2 values (general care wards)

90% 85%

Median = 96%

250 patients 8,400 hrs

Combined impact of threshold and delay settings on SpO2 alarm

•  Delays have the greatest overall benefit in reducing alarms

•  85% SpO2 alarm threshold represents 4 sigma from SpO2 median

•  60 sec delay lowers alarm rate to 2.8 alarm / pt / day

Data based on one institution, 15k hrs

National Benchmark

•  275k+  hours    

•  9500  pa?ent  sessions  

•  16  Hospitals  

May  2015  Aggregate  Analysis  

Parameter   Alarms  

SpO2   3.01  Cardiac  Rate   2.96  

Respira6on  Rate   0.55  NIBP   0.04  cNIBP   0.86  Total   7.42  

Parameter   High  Alarm  Low  Alarm  

Delay  (sec)  

SpO2   -­‐-­‐   85   60  Cardiac  Rate   150   30   30  

Respira6on  Rate   35   4   120  Systolic  Blood  Pressure   190   -­‐-­‐   120  Mean  Arterial  Pressure   -­‐-­‐   60   60  Diastolic  Blood  Pressure   -­‐-­‐   -­‐-­‐   -­‐-­‐  

Jan  –  May  2015  Partner  Hospital  

Parameter   Alarms  

SpO2   1.84  Cardiac  Rate   1.38  

Respira6on  Rate   0.47  NIBP   0.04  cNIBP   1.31  Total   5.03  

•  26  bed  post  surgical  care  unit  •  Policy  to  surveillance  monitor  all  pa?ents  •  Data  capture  Feb  9,  2015  –  May  31,  2015  

delays   thresholds   Alms/pt/day  

Best Practice Hospital

SpO2 OFF/90 OFF/85 1.14PR 60/60 150/29 0.3HR 15/15 150/29 2.69CR 60/60 150/29 1.27RR 120/120 35/4 0.38BP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.06

cNIBP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.43Total 3.29

SpO2 OFF/90 OFF/85 1.14PR 60/60 150/29 0.3HR 15/15 150/29 2.69CR 60/60 150/29 1.27RR 120/120 35/4 0.38BP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.06

cNIBP 240,OFF,OFF/OFF,OFF,60 200,OFF,OFF/OFF,OFF,58 0.43Total 3.29

Leading Indicator Report

•  Generated  for  every  ac?ve  account  every  2  weeks  

•  Reports  alarm  rates  and  #  of  sessions    

•  Nega?ve  trends  reported  to  the  hospitals  

•  Correc?ve  ac?on  implemented  before  nuisance  alarms  are  reported  

Thank you james.welch@soterawireless.com