The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Christopher P. Bonafide, MD, MSCE, Assistant Professor of Pediatrics at the University of Pennsylvania and The Children's Hospital of Philadelphia for his long-term goal of becoming an independent clinical research scientist focused on evaluating interventions to prevent in-hospital cardiac arrest and other adverse events, and translating effective interventions into clinical practice. His immediate goal is to obtain the training, mentorship, and research experience necessary to successfully compete for R01 grants supporting intervention studies in this area. To meet this goal, Dr. Bonafide and his mentors have developed a comprehensive career development plan with four components, including (a) advanced training in clinical informatics, time-to-event analysis, and clinical trial design, (b) intensive mentorship from a team with whom Dr. Bonafide has a track record of collaboration and scholarship including Ron Keren, MD, MPH (primary mentor), Vinay Nadkarni, MD, MS (co-mentor), John Holmes, PhD (co-mentor), and Russell Localio, PhD (senior biostatistics advisor), (c) participation in collaborative research seminars with experts in clinicl effectiveness research, informatics, and medical device engineering, and (d) an innovative research plan to investigate the potential harms associated with physiologic monitoring technology, a critical tool in recognizing early signs of deterioration and preventing cardiac arrest. Despite their great potential, physiologic monitors can generate hundreds of alarms per patient each day, up to 86% of which are false. The candidate hypothesizes that false alarms lead to alarm fatigue, delaying responses to alarms that may represent true signs of impending cardiac or respiratory arrest, and unnecessarily interrupt high-risk tasks leading to errors and patient harm. Dr. Bonafide aims to rigorously evaluate these potential impacts of false alarms in a population of patients at high risk of cardiac arrest and other adverse events: critically ill children with existing or projected heart and/or lung failure. He will use video and direct observational methods to (1) evaluate the patient-oriented impact of alarm fatigue by measuring the association between the rate of false alarms and nurse response time to critical alarms, and (2) determine the association between interruptions due to physiologic monitor alarms and medication administration errors in this high-risk patient population. The findings will provide evidence to support and inform future R01 proposals focused on evaluating strategies to improve the signal-to-noise ratio of physiologic monitors and translating these strategies into clinical practice to prevent in-hospital cardiac arrest and other adverse events. The research and career development activities outlined above will take place in the collaborative academic environment of the University of Pennsylvania and The Children's Hospital of Philadelphia with the support of an internationally-recognized team of mentors and advisors, assuring Dr. Bonafide's success.

Public Health Relevance

High rates of false alarms from physiologic monitors threaten the safety of the over 60,000 Americans hospitalized in intensive care units each day. While physiologic monitoring is a key component of intensive care, monitors generate many unnecessary alarms that are suspected to cause delays in responses to critical warning signs of heart and lung emergencies (alarm fatigue), and interrupt error-prone nursing tasks leading to medication administration errors and patient harm. This proposal seeks to be the first to demonstrate the impacts of false alarms on two outcomes important to public health: response time to critical alarms, and medication administration errors among children with heart and lung conditions.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1)
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Scott, Jane
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Children's Hospital of Philadelphia
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Schondelmeyer, Amanda C; Brady, Patrick W; Goel, Veena V et al. (2018) Physiologic Monitor Alarm Rates at 5 Children's Hospitals. J Hosp Med 13:396-398
Mohan, Shaun; Nandi, Deipanjan; Stephens, Paul et al. (2018) Implementation of a Clinical Pathway for Chest Pain in a Pediatric Emergency Department. Pediatr Emerg Care 34:778-782
MacMurchy, Matt; Stemler, Shannon; Zander, Mimi et al. (2017) Research: Acceptability, Feasibility, and Cost of Using Video to Evaluate Alarm Fatigue. Biomed Instrum Technol 51:25-33
Bonafide, Christopher P; Localio, A Russell; Holmes, John H et al. (2017) Video Analysis of Factors Associated With Response Time to Physiologic Monitor Alarms in a Children's Hospital. JAMA Pediatr 171:524-531
Bonafide, Christopher P; Jamison, David T; Foglia, Elizabeth E (2017) The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors. JAMA 317:353-354
Dewan, Maya; Wolfe, Heather; Lin, Richard et al. (2017) Impact of a Safety Huddle-Based Intervention on Monitor Alarm Rates in Low-Acuity Pediatric Intensive Care Unit Patients. J Hosp Med 12:652-657
Bonafide, Christopher P; Roland, Damian; Brady, Patrick W (2016) Rapid Response Systems 20 Years Later: New Approaches, Old Challenges. JAMA Pediatr 170:729-30
Schondelmeyer, Amanda C; Bonafide, Christopher P; Goel, Veena V et al. (2016) The frequency of physiologic monitor alarms in a children's hospital. J Hosp Med 11:796-798
Paine, Christine Weirich; Goel, Veena V; Ely, Elizabeth et al. (2016) Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency. J Hosp Med 11:136-44
Bonafide, Christopher P; Brady, Patrick W; Daymont, Carrie (2016) Physiologic monitor alarms for children: Pushing the limits. J Hosp Med 11:886-887

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