Poor prognosis for existing monitors in the intensive care unit

OBJECTIVE To identify areas requiring the most urgent improvement in the intensive care unit (ICU); and to accurately determine the positive predictive value of routine critical care patient monitoring alarms, as well as the common causes for false-positive alarms. DESIGN Prospective, observational study. SETTING A multidisciplinary ICU in a university-affiliated children's hospital (excluding children with primary heart disease). INTERVENTIONS The occurrence rate, cause, and appropriateness of all alarms from tracked monitors were recorded by a trained observer and validated by the bedside nurse over a 10-wk period for a single bedspace at a time. MEASUREMENTS AND MAIN RESULTS After 298 monitored hrs, 86% of a total 2,942 alarms were found to be false-positive alarms, while an additional 6% were classified as clinically irrelevant true alarms. Only 8% of all alarms tracked during the study period were determined to be true alarms with clinical significance. Alarms were also classified according to whether they were clearly associated with a "patient intervention" (18%), were clearly not associated with a patient intervention (74%), or had unclear association to interventions (8%). While 11% of "nonpatient intervention" alarms were clinically significant true alarms, only 2% of "patient intervention" alarms were so. Positive predictive values for the various devices ranged from