Title

Safety Huddle Intervention for Reducing Physiologic Monitor Alarms: A Hybrid Effectiveness-Implementation Cluster Randomized Trial.

Year of Publication

2018

Date Published

2018 Feb 27

ISSN Number

1553-5606

Abstract

<p><strong>BACKGROUND: </strong>Monitor alarms occur frequently but rarely warrant intervention.</p>

<p><strong>OBJECTIVE: </strong>This study aimed to determine if a safety huddle-based intervention reduces unit-level alarm rates or alarm rates of individual patients whose alarms are discussed, as well as evaluate implementation outcomes.</p>

<p><strong>DESIGN: </strong>Unit-level, cluster randomized, hybrid effectiveness-implementation trial with a secondary patient-level analysis.</p>

<p><strong>SETTING: </strong>Children's hospital.</p>

<p><strong>PATIENTS: </strong>Unit-level: all patients hospitalized on 4 control (n = 4177) and 4 intervention (n = 7131) units between June 15, 2015 and May 8, 2016. Patient-level: 425 patients on randomly selected dates postimplementation.</p>

<p><strong>INTERVENTION: </strong>Structured safety huddle review of alarm data from the patients on each unit with the most alarms, with a discussion of ways to reduce alarms.</p>

<p><strong>MEASUREMENTS: </strong>Unit-level: change in unit-level alarm rates between baseline and postimplementation periods in intervention versus control units. Patient-level: change in individual patients' alarm rates between the 24 hours leading up to huddles and the 24 hours after huddles in patients who were discussed versus not discussed in huddles.</p>

<p><strong>RESULTS: </strong>Alarm data informed 580 huddle discussions. In unit-level analysis, intervention units had 2 fewer alarms/patient-day (95% CI: 7 fewer to 6 more, P = .50) compared with control units. In patient-level analysis, patients discussed in huddles had 97 fewer alarms/patientday (95% CI: 52-138 fewer, P &lt; .001) in the posthuddle period compared with patients not discussed in huddles. Implementation outcome analysis revealed a low intervention dose of 0.85 patients/unit/day.</p>

<p><strong>CONCLUSIONS: </strong>Safety huddle-based alarm discussions did not influence unit-level alarm rates due to low intervention dose but were effective in reducing alarms for individual children.</p>

DOI

10.12788/jhm.2956

Alternate Title

J Hosp Med

PMID

29489921

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