Patient-centered design of alarm limits in a complex pediatric population

Abstract

In pediatric populations, alarm defaults can be more complex to set, as the normal values for heart rate and respiratory rate vary widely by age range. Therefore we sought to develop more relevant alarm thresholds that were specific to the unique population within our pediatric institution. Complete physiological recordings were collected from 1806 patients in the Progressive Care Unit at Texas Children's Hospital over a five month period in 2014. Patients were grouped by age and centiles plots for Heart Rate, Respiration Rate and SpO2 were calculated and compared to current alarm limits. Comparison of current alarm limits to actual physiologic data shows the mismatch in alarm setting to patient physiology. As an example, the value for the Heart Rate High alarm limit is set such that it falls near the 50% centile, meaning that 50% of the patients will alarm at this value. By re-setting the default settings for Heart Rate, Respiratory Rate and SpO2 limits based on the actual data of a large group of medically complex children, one can reduce non-necessary alarms. However, default alarms need to be set conservatively as complications from complex comorbidities can skew the baseline for the population. Our results demonstrate that age based recommended alarm limits that are derived from healthy cohorts can lead to higher than desired alarm loads in this pediatric population. With data based on the population, more appropriate alarm settings can be derived.

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