Video Analysis of Factors Associated With Response Time to Physiologic Monitor Alarms in a Children’s Hospital

In JAMA Pediatrics, Christopher Bonafide and colleagues, including John Holmes and Ron Keren, seek to identify factors associated with nurses' response time to physiologic monitor alarms at the bedside. As nurse response time to bed alarms remains slow, the authors examine patient- and nurse-related factors that affect responses to alarms. The authors video recorded 551 hours of care administered by 38 nurses to 100 children. They find several variables that shorten nurses’ response time to alarms. These include if the patient was on complex care service, if family members were absent from the bedside, if a nurse had less than 1 year of experience, if there is a 1 to 1 nursing assignment, if there were prior alarms requiring intervention, and if there was a lethal arrhythmia alarm. Each hour that elapsed during a shift was associated with a 15% longer response time, and response time was not associated with the number of nonactionable alarms (alarms that don’t require intervention) in the previous 120 minutes. The authors conclude that response time is associated with factors that likely represent the heuristics nurses use to assess whether an alarm represents a life-threatening condition. The nurse to patient ratio and the number of hours into a shift represent modifiable factors associated with response time. Lastly, chronic alarm fatigue resulting from long-term exposure to non-actionable alarms may be a more important determinant of response time than short-term exposure.