(1282) Types of Audible Patient Monitor Alerts Encountered in a Step-Down Unit

Introduction: Audible bedside monitor alerts are a major contributor to alarm fatigue and patient sleep/rest disruption in step-down units (SDU). The purpose of this study was to identify the most frequent sources of audible monitor alerts generated in one SDU.

Methods: Continuous patient monitoring was performed using a commercial bedside physiologic monitoring system on patients in a surgical-trauma SDU of a large, urban, level one trauma center between April 2018 and November 2022. We extracted all monitor alert data and used manufacturer criteria to determine alert types. We then descriptively analyzed alerts, grouped by audible vs silent, and further by physiologic (i.e., all audible, vital sign-related) and technical (i.e., some audible, equipment-related).

Results: Our sample included 4,147 patients who underwent 515 thousand (K) monitoring hours and generated more than 4.8 million (M) monitor alerts. Of the total monitor alerts, 2.76M (57%) were audible, with 30 unique alerts generating 5.4 alerts per hour per patient. Of the audible alerts, 1.87M (68%) were technical, and 890K (32%) were physiologic. Of the technical audible alerts, the three most frequent sources were due to monitoring sensors (ECG lead detachments [41%], pulse oximetry sensor dysfunction [17%], and poor signal quality [17%]). Of the physiologic audible alerts, the three most frequent sources were due to hypoxemia (47%), bradypnea (13%), and tachycardia (13%).

Conclusions: In this sample of SDU patients, 2/3 of audible alerts were due to technical issues and 1/3 called clinician attention to physiologic instability. Reduction of alarm fatigue and patient rest disruption might be mitigated by better sensor technology and sensor management by clinicians.