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The genesis of alarms in patient monitoring
The technological breakthroughs of the 1940s paved the way for digital patient monitors in the 1950s. These monitors, initially basic, evolved in the 1970s to multimodality devices that could assess multiple parameters, such as blood pressure and electrocardiogram. The late 1970s and 1980s saw the introduction of algorithms, enabling alarms to become a staple in patient monitoring. However, the variance in these alarms hasn’t changed much over time across different vendors and patient populations. This uniformity raises concerns as the same alarm settings apply to both a healthy 35-year-old and an 85-year-old with multiple health issues. A one-size-fits-all approach doesn’t cater to the specific needs of diverse patient groups, who could benefit from customized default settings or alarm limits.
The risks of poorly managed patient alarms prompted The Joint Commission to publish National Patient Safety Goal (NPSG) 6.01.01, aimed at improving the safety of clinical alarm systems (The Joint Commission, 2021).1
The importance of alarms in the patient care environment
As technology rapidly advanced, the realm of clinical alarms remained stagnant. Despite the evolution of artificial intelligence (AI) in healthcare, alarm systems have not seen substantial improvements. In both pediatric and adult acute care, regardless of manufacturer, the same alarm settings are observed. For example, oxygen saturation (SpO2) is often set at 90%. However, healthy individuals typically maintain an SpO2 of 99% or higher, while patients with chronic conditions may never reach 90%. This presents challenges in patient care: healthy individuals could suffer if alarms are triggered at 89%, while chronically ill patients might constantly trip alarms, leading to alarm fatigue, which can result in missed or delayed responses.
Adjusting these parameters often requires manual input from healthcare professionals, typically requiring a physician’s order. This reliance on manual changes introduces the possibility of human error. More often, alarms are simply silenced, introducing another risk to patient care.
Changing the paradigm in alarms
Asking “what if” often leads to innovative approaches. Initially, complex discussions between experts in modeling and simulation sparked new ideas, evolving into opportunities for bringing precision medicine into patient monitoring. Concepts around digital twin technologies, where a virtual replica of the patient is created, have allowed for studying parameter changes against real-world outcomes. AI and machine learning further refine these outcomes to enhance precision.
What sets this approach apart is the use of real-world data from patient monitoring systems, electronic medical records, and secondary devices like infusion pumps and ventilators. This digital twin continuously receives and processes patient data, updating its parameters and improving precision.
The future of monitoring and precision medicine
Science fiction’s vision of the future is now becoming a reality. Patients entering acute care can be connected to monitors that generate a digital twin, with its parameters constantly refined throughout the patient’s stay. This system can integrate with alarm technologies to send actionable alerts when necessary. In this setup, AI becomes a safeguard against human error, enabling patients to be shifted between care paradigms as needed.
This approach not only aligns with but exceeds the standards set by NPSG 6.01.01, offering a promising future for clinical alarm systems. The ultimate goal is to provide every patient with access to precision medicine that improves outcomes and assists clinicians in delivering optimal care.
The future of precision medicine is now
There is an ethical responsibility to bring precision medicine to patient monitoring across all modalities. The healthcare industry has unlocked new possibilities in patient care, and it is crucial to ensure that every patient benefits from technologies that enhance outcomes and support clinical decision-making.
Reference
- The Joint Commission. (2021). National Patient Safety Goals®, Effective January 2021 for the Hospital Program.
Ravjeet Sandher isa a Client Executive at Medidata.
For more information visit www.medidata.com.
