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Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
As was discussed in Chapter 2, alarm reporting from PCDs is key to alerting clinical staff of adverse events. Yet, the alarm fatigue associated with responding to many nuisance alarms may result in clinical staff missing real events, or cause the machine alarms to be ignored or even turned off, negating any potential benefit of alarms at all.
Looking at Causality
Published in George Mayzell, The Resilient Healthcare Organization, 2020
Society also has different expectations of physicians from what it had in the past. In general, people now have more immediate expectations and just-in-time needs for treatment. There is no informational downtime, and expectations are 24/7/365. In concert with these expectations are new communication strategies such as Electronic visits (E-visits) and mobile health. Smart phones make it impossible to get away from the constant communication that is part of a medical delivery system. It can also lead to alert fatigue, making it difficult to separate true emergencies from false alarms.
Continuous glucose monitoring in pregnancy
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Marlon Pragnell, Aaron Kowalski
RT-CGM systems can be set to alert the wearer when glucose values are too high or low via audible and/or vibration alarms. These are particularly useful when the user does not usually perform SMBG finger sticks, such as the first few hours following a meal and overnight—a particularly vulnerable time for hypoglycemic seizures. Alerts are also optional for the rate of glucose rise and fall. To avoid alarm fatigue, these can be customized based on individual safety, tolerance for alerts, and the time of day (using different thresholds during the daytime and nighttime).
Cost savings through continuous vital sign monitoring in the medical-surgical unit
Published in Journal of Medical Economics, 2023
John W. Beard, Antra Sethi, Weiqi Jiao, Hayden W. Hyatt, Halit O. Yapici, Mary Erslon, Frank J. Overdyk
Recent innovations in wireless, wearable technologies have increased monitoring parameter sensitivity and specificity that is likely to improve patient well-being and increase the potential for downstream cost-savings. One such wireless, wearable continuous monitoring system, PortraitTM Mobile, (GE HealthCare, Chicago, IL) was demonstrated to have high sensitivity for respiratory rate and significantly fewer artifacts than capnography; the reported accuracy of this device was also higher than currently available devices33. Advancements in device sensitivity and specificity will also increase the ability to detect adverse events and decrease false alarms that contribute to alarm fatigue57. Modern technologies such as PortraitTM Mobile further address alarm fatigue by enabling configuration of alarm level and time delay thresholds tailored to the baseline values for individual patients or for specific medical-surgical units. These advancements in monitoring capabilities will further supplement the patient monitoring provided by clinicians and patients themselves, and successful monitoring will still require the insights of the clinicians providing care for their patients. A majority of patients report feeling safer with continuous monitoring during hospitalization58, and interviews with nursing staff have indicated the importance of maintaining frequent nurse-patient interactions55.
Technical quality assurance and quality control for medical laboratories: a review and proposal of a new concept to obtain integrated and validated QA/QC plans
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Setting up autoverification rules is something that every laboratory must do for every test. Generally, this is based on expert opinion together with a risk assessment. This can be based on risk related to performing a manual procedure, assay stability and reliability, known pre-analytical issues, clinical impact of an erroneous result, supplier guidelines, or any other variable considered relevant. Then, a relevant step is to define the quality goals for intended use. Furthermore, the “workload” associated with autoverification rules can be a factor in establishing such rules. For rather stable and reliable high-volume processes, in my experience, the alarm-rate workload is a major factor in deciding on autoverification rules. Also, for practical reasons, any manual verification action that originates from autoverification rules must be manageable and alarm fatigue should be avoided at all times (i.e. when the process is in control). Alarm fatigue would undermine the ability of the system to detect error by neglecting relevant alarms or notifications. Optimization of the autoverification rules indicates the procedure to select settings that allow for optimal performance based on the variables considered relevant for a specific laboratory. These can include alarm rate and error detection performance characteristics. Validation of autoverification rules is then the objective performance of a specified set of optimized and final autoverification rules. As for iQC, validation should be based on both the alarm rate and the error detection properties for a range of errors considered relevant.
The Lean and Agile Multi-dimensional Process (LAMP) – a new framework for rapid and iterative evidence generation to support health-care technology design and development
Published in Expert Review of Medical Devices, 2020
Melody Ni, Simone Borsci, Simon Walne, Anna P. Mclister, Peter Buckle, James G. Barlow, George B. Hanna
Closely related to this is integration of new technology in terms of both functionalities and interfaces during its implementation. Technologies developed and introduced sequentially, by different manufacturers, at different times seldom work well together. Worse still, by competing for limited attention of busy clinicians, the benefits they are designed to deliver are being canceling out. For instance, alarm fatigue has become a well-known issue in a busy clinical environment. The issue is becoming acute as health-apps are being developed at an unprecedented speed and are routinely used in combination with other apps. This threatens the fidelity of clinical guidelines which underpins standard clinical practice. To achieve smooth integration requires forward thinking in regulation, clinical guideline development, and technology assessments. Assessments of ‘compatibility’ of a new concept with the existing clinical environment should become an integral part of early assessments, above and beyond the comparison against current practice for establishing value. Such considerations must also inform design of clinical studies so that relevant risks can be measured and mitigated before introducing the technology into the clinical practice.