The broad objective of this proposal is to establish a pediatric Patient Safety Learning Laboratory (PSLL) at Children?s Hospital of Philadelphia (CHOP). Working in a transdisciplinary fashion, CHOP PSLL investigators will collaboratively apply innovative scientific approaches that integrate their respective disciplines to achieve the goal of analyzing and re-engineering hospital and home physiologic monitoring systems to maximize alarm informativeness. Current systems used to continuously monitor children?s vital signs in hospital ward and home settings generate alarms intended to warn caretakers? nurses in the hospital and parents at home? of conditions that warrant their immediate attention. However, both systems suffer from low informativeness and thus pose patient safety risks such as alarm fatigue that are relevant to critical illness detection, diagnosis, and treatment. This PSLL brings together expertise from CHOP, University of Pennsylvania, and the ECRI Institute in diverse areas including patient safety, pediatric hospital medicine, neonatology, nursing, systems engineering, human factors, design, medical device development, electronic health record clinical decision support, cognitive informatics, simulation, and biostatistics. The project?s Specific Aims are (1) Re-engineer the system of monitoring hospitalized children on acute care wards, with a focus on reducing non-informative alarms and accelerating nurse responses to critical events, and (2) Re-engineer the system of monitoring infants with bronchopulmonary dysplasia at home, with a focus on reducing non-informative hypoxemia alarms and improving clinicians? access to usable longitudinal pulse oximetry data to inform supplemental oxygen treatment.
Each Aim will proceed through a stepwise process of problem analysis, design, development, implementation, and evaluation. This project will use a framework based on the Systems Engineering Initiative for Patient Safety (SEIPS) model and Dual Process Theory, and will apply innovative methods such as forensic accident investigation, video alarm analysis, and in situ simulation to analyze and evaluate monitoring systems. The end products will be redesigned systems for physiologic monitoring in hospitals and homes and a sustainable pediatric Patient Safety Learning Laboratory at one of the top children?s hospitals in the nation.
Current systems for monitoring ill children?s vital signs on hospital wards and in homes are estimated to generate in excess of 10 million unnecessary alarms in the United States annually. These alarms lead to alarm fatigue in the nurses and caregivers responsible for responding when something is wrong, resulting in downstream harm to children if truly critical events are missed or ignored. The findings of the Children?s Hospital of Philadelphia Patient Safety Learning Laboratory will be immediately relevant to the millions of children and adults admitted to hospitals annually whose vital signs are continuously monitored and the tens of thousands of technology-dependent children and adults living at home who rely on physiologic monitoring to detect deteriorating illness.