Low amplitude QRS in a patient with an excessive number of alarms.

<p>Standard “diagnostic” 12-lead ECG recorded from the patient who contributed nearly half of the 12,671 arrhythmia alarms for annotation. The ECG shows left bundle branch block with low amplitude QRS complexes in the limb leads but not in the V leads. Since one of the available leads acquired with the physiologic patient monitoring device is a V lead, the arrhythmia algorithm could have avoided the excessive number of false alarms had all available leads been used for QRS detection.</p

Frequency of all unique alarms (N = 2,558,760) over a 31-day period.

<p>Frequency of all unique alarms (N = 2,558,760) over a 31-day period.</p

Physiologic monitor device in Intensive Care Unit.

<p>Bedside patient monitor (GE Healthcare, Milwaukee, WI) displays multiple physiologic waveforms and vital sign measurements. The nurse pictured here gave written informed consent to publish this photograph supplied by the San Francisco Chronicle newspaper (with permission) for their story on alarm fatigue at: <a href="http://www.sfgate.com/health/article/Hospitals-look-to-reduce-danger-of-alarm-fatigue-4918018.php" target="_blank">http://www.sfgate.com/health/article/Hospitals-look-to-reduce-danger-of-alarm-fatigue-4918018.php</a>.</p

ST-Segment Alarm Durations in a 16-Bed Cardiac ICU.

<p>ST-Segment Alarm Durations in a 16-Bed Cardiac ICU.</p

Hospital infrastructure to automatically store all physiologic monitor waveform and alarm data.

<p>Hospital infrastructure to automatically store all physiologic monitor waveform and alarm data.</p

False apnea alarm in a patient breathing adequately on mechanical ventilation.

<p>The respiratory waveform (bottom tracing labelled “Resp”) has a flat line appearance. The detection of respirations from the ECG lead (impedance method) is inaccurate in this patient, displaying an erroneous respiratory rate of 4 per minute.</p

False accelerated ventricular rhythm alarm in a patient with left bundle branch block.

<p>Sinus rhythm at a rate in the 60′s is evident by observing P waves preceding each QRS complex with a consistent PR interval. P waves are visible in all seven leads (especially clear-cut in Leads I and II).</p

Frequency of Visible QRS Complexes in One or More ECG Leads during False Brady-Arrhythmia Alarms.

<p>Frequency of Visible QRS Complexes in One or More ECG Leads during False Brady-Arrhythmia Alarms.</p

Key Insights into the Problem of Alarm Fatigue and Recommendations.

<p>Afib = atrial fibrillation; AAMI = Association for the Advancement of Medical Instrumentation; HR = heart rate; BBB = bundle branch block; VT = ventricular tachycardia; VFib = ventricular fibrillation; RR = respiratory rate.</p><p>Key Insights into the Problem of Alarm Fatigue and Recommendations.</p

ECG signal quality in 12,671 annotated arrhythmia alarms.

<p>Good signal quality (green) was defined as a clearly visible P-QRS-T waveform across all available leads with little to no noise, baseline wander, or leads off. Fair signal quality (yellow) was defined as moderate noise or baseline wander but having identifiable QRS complexes for basic rhythm/rate detection. Poor signal quality (red) was defined as being unanalyzable because of excessive noise, baseline wander or leads off.</p