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Alarm in the ICU! Envisioning Patient Monitoring and Alarm Management in Future Intensive Care Units

  • Elif ÖzcanEmail author
  • Dilip Birdja
  • Lianne Simonse
  • Ard Struijs
Chapter

Abstract

Today’s intensive care units (ICUs) pose a design dilemma considering the use of technology and its psychological effects on the inhabitants of the ICU. While the ICUs are designed to be technologically advanced in order to ensure patient safe recovery, the very technology that ICUs rely on threatens patients’ as well as clinicians’ wellbeing. Especially the system behind patient monitoring and the consequent alarm management needs to be reconsidered from the human perspective to prevent any occurrences of clinician alarm fatigue and post-traumatic stress syndrome observed in patients as well as their visitors. Moreover, advancements in patient monitoring technology, medical informatics, and societal developments offer new possibilities to give patient data a central role specifically in alarm management and clinician workflow in the ICUs in general. In this chapter, we envision a data-driven product-service system for patient monitoring in the future critical care context. Our design ideas and future vision are based on a critical review of the literature in patient monitoring, trend analysis, and technological developments in medical care, followed by a stakeholder analysis, the design of a future vision concept and scenario that we validated with expert interviews.

Notes

Acknowledgements

This chapter is based on the master thesis of Eng. Dilip Birdja who graduated at the Critical Alarms Lab of the Delft University of Technology (March, 2018). The authors also wish to acknowledge the valuable comments of Zoran Trogrlic, Jasper van Bommel, Muriel Stolk, Diederik Gommers (Erasmus Medical Centre, Adult Intensive Care), Gerard Keizer (DGA Care), and Michael Sonne Kristensen (Plymouth University) during the conceptualisation phase of the ideas as well as writing of the chapter.

References

  1. AHRQ – Health Care Innovations Exchange. (2009). Modified Early Warning System (MEWS). Agency for Healthcare Research and Quality (AHRQ, Ed.). Retrieved on April 4, 2018, from https://innovations.ahrq.gov/qualitytools/modified-early-warning-system-mews
  2. Birdja, D. V. (2018). Exploring possibilities for patient monitoring in the future care context. Master thesis, Delft University of Technology, Delft.Google Scholar
  3. Borowski, M., Görges, M., Fried, R., Such, O., Wrede, C., & Imhoff, M. (2011). Medical device alarms. Biomedizinische Technik, 56, 73–83.  https://doi.org/10.1515/bmt.2011.005 CrossRefGoogle Scholar
  4. CGI. (2014). Healthcare challenges and trends: the patient at the heart of care. Montreal: Conseillers en Gestion et Informatique (CGI, Ed.).Google Scholar
  5. CPB. (2017). Pensioenen en Vergrijzing. Centraal Planbureau (CPB, Ed.). Retrieved on April 04, 2018, from https://www.cpb.nl/onderwerp/pensioenen-en-vergrijzing
  6. Cvach, M. (2012). Monitor alarm fatigue: An integrative review. Biomedical Instrumentation and Technology, 46(4), 268–277.CrossRefGoogle Scholar
  7. Day, H. W. (1968). Acute coronary care: A five-year report. American Journal of Cardiology, 21(2), 252–257.CrossRefGoogle Scholar
  8. Deloitte. (2017). Global health care outlook: Making progress against persistent challenges. Retrieved on April 8, 2018, from https://www2.deloitte.com/insights/us/en/industry/dcom/2017-global-health-care-sector-outlook.html
  9. Drew, B. J., Harris, P., Zègre-Hemsey, J. K., Mammone, T., Schindler, D., Salas-Boni, R., et al. (2014). Insights into the problem of alarm fatigue with physiologic monitor devices: A comprehensive observational study of consecutive intensive care unit patients. PLoS One, 9(10), e110274.CrossRefGoogle Scholar
  10. Edmondson, D., Richardson, S., Falzon, L., Davidson, K. W., Mills, M. A., & Neria, Y. (2012). Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: A meta-analytic review. PLoS One, 7(6), e38915.CrossRefGoogle Scholar
  11. Fairman, J., & Kagan, S. (1999). Creating critical care: The case of the hospital of the University of Pennsylvania, 1950–1965. Advanced Nursing Science, 22(1), 63–77.CrossRefGoogle Scholar
  12. Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 19(1), 28–34.  https://doi.org/10.4037/ajcc2010651 CrossRefGoogle Scholar
  13. Griffiths, J., Fortune, G., Barber, V., & Young, J. D. (2007). The prevalence of post-traumatic stress disorder in survivors of ICU treatment: A systematic review. Intensive Care Medicine, 33(9), 1506–1518.CrossRefGoogle Scholar
  14. Hannibal, G. B. (2011). Monitor alarms and alarm fatigue. AACN Advanced Critical Care, 22(4), 418–420.CrossRefGoogle Scholar
  15. Haupt, M. T., Bekes, C. E., Brilli, R. J., Carl, L. C., Gray, A. W., Jastremski, M. S., et al. (2003). Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Critical Care Medicine, 31(11), 2677–2683.CrossRefGoogle Scholar
  16. Health Catalyst. (2015). Top 7 healthcare trends and challenges from 2015. Health Catalyst (Ed.). Retrieved on April 4, 2018, from https://www.healthcatalyst.com/top-healthcare-trends-challenges
  17. Kristensen, M. S., Edworthy, J., & Özcan, E. (2016). Alarm fatigue in the ward: An acoustical problem? Sound Effects, 6(1), 88–104.Google Scholar
  18. Kristensen, M. S., Edworthy, J., Özcan, E., & Denham, S. (2015, December). Alarm fatigue in the perception of medical soundscapes. In European congress and exposition on noise control engineering (pp. 745–750).Google Scholar
  19. Lewis, B. A., & Baldwin, C. L. (2012). Equating perceived urgency across auditory, visual, and tactile signals. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 56(1), 1307–1311.  https://doi.org/10.1177/1071181312561379 CrossRefGoogle Scholar
  20. Marshall, J. C., Bosco, L., Adhikari, N. K., Connolly, B., Diaz, J. V., Dorman, T., et al. (2017). What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care, 37, 270–276.  https://doi.org/10.1016/j.jcrc.2016.07.015 CrossRefGoogle Scholar
  21. Meeuwen, D. P., van Walt Meijer, Q. J., & Simonse, L. W. L. (2015). Care models of eHealth services: A case study on the design of a business model for an online precare service. JMIR Research Protocols, 4(1), e32.CrossRefGoogle Scholar
  22. Mejia Sarmiento, R., & Simonse, L. W. L. (2018). Vision concept. In L. Simonse (Ed.), Design roadmapping (pp. 84–87). Amsterdam: BIS Publishers.Google Scholar
  23. Ontomed. (2018). Quantitative complexity theory applications in medicine, White Paper. Ontomed (Ed.). Retrieved on April 4, 2018, from http://www.ontomed.net/publications/
  24. Oosterholt, R., Simonse, L., Boess, S., & Vehmeijer, S. (2017). Designing a care pathway model – A case study of the outpatient total hip arthroplasty care pathway. International Journal of Integrated Care, 17(1), 1–14.CrossRefGoogle Scholar
  25. PwC. (2017). Emerging trends in healthcare. PricewaterhouseCoopers (PwC, Ed.). Retrieved on April 4, 2018, from https://www.pwc.com/gx/en/industries/healthcare/emerging-trends-pwc-healthcare.html
  26. Reisner-Sénélar, L. (2011). The birth of intensive care medicine: Björn Ibsen’s records. Intensive Care Medicine, 37(7), 1084–1086.  https://doi.org/10.1007/s00134-011-2235-z CrossRefGoogle Scholar
  27. Safar, P., DeKornfeld, T., Pearson, J., & Redding, J. (1961). The intensive care unit. Anaesthesia, 16(3), 275–284.CrossRefGoogle Scholar
  28. Sheingold, B. H., & Hahn, J. A. (2014). The history of healthcare quality: The first 100 years 1860–1960. International Journal of Africa Nursing Sciences, 1, 18–22.  https://doi.org/10.1016/j.ijans.2014.05.002 CrossRefGoogle Scholar
  29. Smith, G., & Nielsen, M. (1999). ABC of intensive care: Criteria for admission. BMJ, 318(7197), 1544–1547.CrossRefGoogle Scholar
  30. Society of Critical Care Medicine. (1999). Guidelines for intensive care unit admission, discharge, and triage. Task force of the American College of Critical Care Medicine. Critical Care Medicine, 27(3), 633–638.CrossRefGoogle Scholar
  31. Stanford Medicine. (2017). Harnessing the power of data in health. Stanford Medicine (Ed.). Retrieved on April 1, 2018, from https://med.stanford.edu/content/dam/sm/sm-news/documents/StanfordMedicineHealthTrendsWhitePaper2017.pdf
  32. Subbe, C. P., Kruger, M., Rutherford, P., & Gemmel, L. (2001). Validation of a modified Early Warning Score in medical admissions. QJM, 94(10), 521–526.CrossRefGoogle Scholar
  33. The Joint Commission. (2013). Medical device alarm safety in hospitals. Sentinel Event Alert (50). Retrieved on April 1, 2018, from https://www.jointcommission.org/assets/1/6/SEA_50_alarms_4_26_16.pdf
  34. Tsien, C. L., & Fackler, J. C. (1997). Poor prognosis for existing monitors in the intensive care unit. Critical Care Medicine, 25(4), 614–619.CrossRefGoogle Scholar
  35. Tulloch, H., Greenman, P. S., & Tassé, V. (2014). Post-traumatic stress disorder among cardiac patients: Prevalence, risk factors, and considerations for assessment and treatment. Behavioral Science (Basel), 5(1), 27–40.CrossRefGoogle Scholar
  36. Vachon, F. (2011). Histoire de la réanimation médicale française: 1954–1975. Réanimation, 20(1), 72–78.  https://doi.org/10.1007/s13546-010-0141-y CrossRefGoogle Scholar
  37. Valentin, A., & Ferdinande, P. (2011). Recommendations on basic requirements for intensive care units: Structural and organizational aspects. Intensive Care Medicine, 37(10), 1575–1587.CrossRefGoogle Scholar
  38. Van der Aalst, M. (2018). Factsheet Arbeidsmarkt. Zorg, Uitvoeringsinstituut Werknemersverzekeringen (Ed.). Retrieved on April 4, 2018, from https://www.uwv.nl/overuwv/Images/Factsheet_Zorg.pdf
  39. Vincent, J. L. (2013). Critical care: where have we been and where are we going? Critical Care, 17(Suppl 1), S2.  https://doi.org/10.1186/cc11500 CrossRefGoogle Scholar
  40. Wilson, C. B. (1999). Sensors in medicine. British Medical Journal, 319(7220), 1288.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elif Özcan
    • 1
    • 2
    Email author
  • Dilip Birdja
    • 1
  • Lianne Simonse
    • 1
  • Ard Struijs
    • 2
  1. 1.Critical Alarms Lab, Faculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
  2. 2.Department of Adult Intensive CareErasmus Medical Centre RotterdamRotterdamNetherlands

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