How health systems can measure the effects of hospital-acquired infections and unactionable alarms

Hospital-acquired infections are growing more difficult to treat due to rise of antibiotic resistance. These infections pose dangerous health consequences for patients and threaten hospitals' bottom lines.

More hospitals are implementing new technologies, introducing new devices or testing machine learning algorithms to predict patients' risk of infection and diagnosis or treat them sooner.

However, as more of these technologies and devices that alert clinicians to potential events are introduced into patient rooms, the risk of alarm fatigue — or clinician desensitization to the alarms — increases.

Research shows that at least 75 percent of alarms are nonactionable, explained Peter Mallow, PhD, director of health economics and clinical outcomes research and assistant professor at Xavier University in Cincinnati. These nonactionable alarms can contribute to alarm fatigue, he added.

"One missed alarm could be the cause for a whole lot of headaches, but at the same time our clinicians and techs are overwhelmed by these monitors constantly sounding for unactionable items," Dr. Mallow said.

Here, Dr. Mallow, who is also an advisor to Cardinal Health, discusses the direct and indirect costs of HAIs for hospitals and shares tips on how to address the issue of alarm fatigue with administrators. He also touches on his most surprising research finding and explains how systems can measure the effects of HAIs and unactionable alarms.

Editor's Note: Responses have been lightly edited for length and clarity. 

Question: What are some of the most detrimental costs that hospitals can incur due to HAIs?

Dr. Peter Mallow:  I want to be clear that HAIs sound like they're hospital caused. We must get past that mindset. We need to create a culture where we can be talking about these constantly so we can focus on the patient and find ways to prevent these, though we're not going to be able to prevent all of them. With this thought in mind, the most impactful cost quite simply is to the patient whose stay is extended, or in the worst case never gets to go home. As a result of that patient impact, the hospitals do incur an economic cost. If a patient gets an HAI, chances are the length of stay will be extended. While it varies widely, the additional length of stay associated with HAIs can directly cost hospitals several hundred million to even billions of dollars each year under the MS-DRG system or capitated payment model. Additionally, hospitals can face reimbursement penalties of up to 1 percent by Medicare if they are among the worst-performing hospitals with respect to HAIs. There is also the potential for lawsuits and harm to brand reputation. All of these consequences can lead to significant costs for health systems.

Q: Responding to false or unactionable alarms in patient rooms can be overwhelming and time-consuming. How can clinicians or unit managers elevate this issue to their administrators?

PM: The number of connected devices in patient rooms is overwhelming. Those devices all have beeps, buzzes, signals, flashes and occasional wails. Research has shown that at least 75 percent of those alerts are considered clinically irrelevant or unactionable. The fear is that if the devices don't sound, a provider may miss clinically relevant alarms and cause patient harm. The healthcare industry is very focused on identifying every potential event, and that comes at the cost of getting those false positives quite often. One missed alarm could be the cause for a whole lot of headaches, but at the same time our clinicians and techs are overwhelmed by these monitors constantly sounding for unactionable items.

The best way to get an administrator's attention regarding the time lost to false or unactionable alarms is to make it personal. Invite the administrator to observe the floor for several hours or the better part of a shift to experience it firsthand. Get administrators to see their own staff interacting with all those alarms and how distracting it can be. 

Q: You've conducted research on decision-making within complex organizations, and health systems. What has been the most surprising research finding?  

PM: The most surprising finding that I come across in my research time and time again is that we often miss the proper unit of analysis or endpoint when we are working to implement quality improvement programs or conducting outcomes research. There are often limitations in resources, time or data, which force a different metric to be examined. As a result, the wrong metric is the focus of the research and interpretation rather than something that is truly meaningful and relevant to the facility. We must better recognize the limitations of those endpoints we choose upfront. 

Q: How should hospitals measure the impact of HAIs and false alarms on their facilities and ensure they are choosing the right metrics?

PM: Healthcare systems and the hospitals within them have their own culture, protocols, procedures — both written and unwritten — that when combined with a possible problem related to HAIs and false alarms make for a unique situation. I would suggest that a hospital administrator spend time on the floor with the clinicians to define what exactly is a false alarm for your setting. From there, I would count the false alarms and pull in one or two problematic HAIs. The mere act of counting and sharing the data will yield beneficial results. For those healthcare systems and hospitals doing the basics, consider a patient level-cost accounting system. Share the data as close to real time as possible. Again, the mere act of counting the costs at the patient level will yield good results. With time, ideas to improve HAIs will turn into actions, and from these bottom-up actions, hospital- and system- level practices will emerge to fit established culture, protocols and procedures of your institution.

To learn more on how you can help reduce the risk of HAIs and limit false alarms in your facility visit

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