Fewer emergency department alarms is associated with reduced use of medications for acute agitation

Andy Hung-Yi Lee; Patrick P Lowe; Jane M Hayes; Martin S Copenhaver; Rebecca E Cash; Maria Aristizabal; Yosef Berlyand; Joshua J Baugh; Lauren M Nentwich; Wendy L Macias-Konstantopoulos; Ali S Raja; Jonathan D Sonis

doi:10.1016/j.ajem.2024.04.021

Fewer emergency department alarms is associated with reduced use of medications for acute agitation

Am J Emerg Med. 2024 Apr 20:81:111-115. doi: 10.1016/j.ajem.2024.04.021. Online ahead of print.

Affiliations

¹ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, UCLA David Geffen School of Medicine, 1100 Glendon Ave Suite 1200, Los Angeles, CA, USA. Electronic address: andyhlee@mednet.ucla.edu.
² Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA.
³ Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Healthcare Systems Engineering, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA.

PMID: 38733663
DOI: 10.1016/j.ajem.2024.04.021

Abstract

Background and objectives: Patient monitoring systems provide critical information but often produce loud, frequent alarms that worsen patient agitation and stress. This may increase the use of physical and chemical restraints with implications for patient morbidity and autonomy. This study analyzes how augmenting alarm thresholds affects the proportion of alarm-free time and the frequency of medications administered to treat acute agitation.

Methods: Our emergency department's patient monitoring system was modified on June 28, 2022 to increase the tachycardia alarm threshold from 130 to 150 and to remove alarm sounds for several arrhythmias, including bigeminy and premature ventricular beats. A pre-post study was performed lasting 55 days before and 55 days after this intervention. The primary outcome was change in number of daily patient alarms. The secondary outcomes were alarm-free time per day and median number of antipsychotic and benzodiazepine medications administered per day. The safety outcome was the median number of patients transferred daily to the resuscitation area. We used quantile regression to compare outcomes between the pre- and post-intervention period and linear regression to correlate alarm-free time with the number of sedating medications administered.

Results: Between the pre- and post-intervention period, the median number of alarms per day decreased from 1332 to 845 (-37%). This was primarily driven by reduced low-priority arrhythmia alarms from 262 to 21 (-92%), while the median daily census was unchanged (33 vs 32). Median hours per day free from alarms increased from 1.0 to 2.4 (difference 1.4, 95% CI 0.8-2.1). The median number of sedating medications administered per day decreased from 14 to 10 (difference - 4, 95% CI -1 to -7) while the number of escalations in level of care to our resuscitation care area did not change significantly. Multivariable linear regression showed a 60-min increase of alarm-free time per day was associated with 0.8 (95% CI 0.1-1.4) fewer administrations of sedating medication while an additional patient on the behavioral health census was associated with 0.5 (95% CI 0.0-1.1) more administrations of sedating medication.

Conclusion: A reasonable change in alarm parameter settings may increase the time patients and healthcare workers spend in the emergency department without alarm noise, which in this study was associated with fewer doses of sedating medications administered.

Keywords: Agitation; Alarms; Cardiac monitoring.