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Introduction: Clinical alarms are frequent, often non-actionable, and, if excessive, pose threats to patient safety by creating alarm fatigue. Prior pediatric studies were limited and may have not accurately captured the degree of alarm burden in the hospital setting. We aimed to describe alarm burden over a 1-year period and explored variations in alarm rates stratified by unit type, alarm source, and cause.

Methods: We conducted a retrospective study of internal clinical alarm and patient census data at Children’s Mercy from January 2019 through December 2019, including 8 inpatient units: 6 medical/surgical (M/S), 1 pediatric intensive care unit (PICU), and 1 neonatal intensive care unit (NICU). Alarm rates per patient day were calculated. Rates were stratified by unit type, alarm source (e.g., pulse oximetry probe), and cause (e.g., apnea). Poisson regression determined p-values for comparisons.

Results: There were 84,077 patient days and 7,934,997 alarms included. Overall rate of 94.4 alarms per patient day (95% confidence interval [CI] 94.3 to 94.4; Table 1). Significant differences in overall alarm rates existed across inpatient unit types (117.5 NICU vs 90.7 PICU vs 81.3 M/S; p<.001). Pulse oximetry probe alarms had highest rate by source (54.4; 95%CI 54.3 to 54.4) followed by cardiorespiratory leads (31.0; 95%CI 31.0 to 31.1). There was significant variation in alarm rates by source across unit types. PICU had lowest rate of pulse oximetry probe alarms (92.6 NICU vs 33.3 PICU vs 37.6 M/S; p<.001), while NICU had lowest rate of cardiorespiratory lead alarms (16.2 NICU vs 31.4 PICU vs 40.1 M/S; p<.001). Similarly, alarms stratified by cause displayed significant variation across unit types with low oxygen saturation alarms having highest overall rate (43.4; 95%CI 43.3 to 43.4) followed by technical alarms (16.3; 95%CI 16.3 to 16.4). Intensive care units had higher rates of low oxygenation alarms compared to M/S (79.6 NICU vs 27.1 PICU vs 26.3 M/S; p<.001), but lower rates of technical alarms (3.4 NICU vs 15.8 PICU vs 24.5 M/S; p<.001).

Conclusions: Our inpatient units experienced very frequent clinical alarms with wide variability in alarm rates across unit types. By studying alarm rates over a full year, our work builds upon existing literature showing that alarms arising from pulse oximetry monitoring are the most significant contributor to clinical alarm burden at children’s hospitals, but that unit type may play a role in alarm burden. Efforts should be aimed at reducing non-actionable pulse oximetry alarms.

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Variations in Rates of Clinical Alarm Burden, Source, and Cause Across Inpatient Unit Types at a Children’s Hospital