Currently submitted to: JMIR Formative Research
Date Submitted: Mar 14, 2024
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Alarm management in provisional COVID-19 intensive care units: a retrospective analysis and recommendations for future pandemics
ABSTRACT
Background:
In response to the high patient admission rates during the SARS-CoV-2 (COVID) pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We aimed to find out whether the provisional ICU setting led to a greater alarm burden and more alarm fatigued staff.
Objective:
We aimed to compare the alarm situation between provisional COVID ICUs non-COVID ICUs during the second Corona wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by healthcare staff.
Methods:
Our approach involved a comparative analysis of alarm data from two provisional COVID-19 ICUs and two stationary non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the two ICU types. We analyzed alarm log data from the patient monitoring systems of all participating ICUs to inferentially check the differences. Additionally, we assessed staff’s alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on healthcare personnel.
Results:
COVID ICUs had significantly more alarms per bed per day than non-COVID ICUs and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-specific alarm type patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs were alarm fatigued. However, physicians and nurses in COVID ICUs showed a significantly higher level of alarm fatigue.
Conclusions:
Staff in COVID ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management as part of the preparations emphasizing the importance of alarm management training for future pandemics.
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