ARTEMIS: An alarm threshold and policy mining system for the intensive care unit

BACKGROUND

Alarm fatigue is a major technology-induced hazard for patients and staff in intensive care units. Too many - mostly unnecessary - alarms cause desensitisation and lack of response in medical staff. Unsuitable alarm policies are one reason for alarm fatigue. But changing alarm policies is a delicate issue since it concerns patient safety.

OBJECTIVE

We present ARTEMIS, a novel, computer-aided clinical decision support system for policy makers that can help to considerably improve alarm policies using data from hospital information systems.

METHODS

Policy makers can use different policy components from ARTEMIS' internal library to assemble tailor-made alarm policies for their intensive care units. Alternatively, policy makers can provide even more highly customised policy components as Python functions using data the hospital information systems. This can even include machine learning models - for example for setting alarm thresholds. Finally, policy makers can evaluate their system of policies and compare the resulting alarm loads.

RESULTS

ARTEMIS reports and compares numbers of alarms caused by different alarm policies for an easily adaptable target population. ARTEMIS can compare policies side-by-side and provides grid comparisons and heat maps for parameter optimisation. For example, we found that the utility of alarm delays varies based on target population. Furthermore, policy makers can introduce virtual parameters that are not in the original data by providing a formula to compute them. Virtual parameters help measuring and alarming on the right metric, even if the patient monitors do not directly measure this metric.

CONCLUSION

ARTEMIS does not release the policy maker from assessing the policy from a medical standpoint. But as a knowledge discovery and clinical decision support system, it provides a strong quantitative foundation for medical decisions. At comparatively low cost of implementation, ARTEMIS can have a substantial impact on patients and staff alike - with organisational, economic, and clinical benefits for the implementing hospital.

A framework to characterize the performance of early warning index alarm systems for patient monitoring

In [Scully, C.G., and Daluwatte, C., Evaluating performance of early warning indices to predict physiological instabilities. J Biomed Inform. 75 (2017) 14–21], a framework was presented to characterize the performance of warning indices to provide information on the 1) probability a critical health event will occur when a warning is given (analogous to positive predictive value) and 2) proportion of warned events to all events (analogous to sensitivity). This framework also provides information about the timeliness of the warnings with respect to event occurrence and the warning burden of the system.

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In the current work, we provide information on how this framework can be used when cases without events are present in a dataset to examine the proportion of warned non-events to all non-events (analogous to false positive rate).

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Information on steps to apply the method, software, data and results for the case study are also provided to enable implementation of the framework.

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Application and extension of the framework is demonstrated and discussed by adding non-event records to our previous case study comparing two warning strategies to predict physiologic instabilities.

A method to remove chattering alarms using median filters

Chattering alarms are the most found nuisance alarms that will probably reduce the usability and result in a confidence crisis of alarm systems for industrial plants. This paper addresses the chattering alarm reduction using median filters. Two rules are formulated to design the window size of median filters. If the alarm probability is estimated using process data, one rule is based on the probability of alarms to satisfy some requirements on the false alarm rate, or missed alarm rate. If there are only historical alarm data available, the other rule is based on percentage reduction of chattering alarms using alarm duration distribution. Experimental results for industrial cases testify that the proposed method is effective.