Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 27, 2024
Date Accepted: Nov 2, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Call for decision support for ECG alarm administration among NICU staff: findings from a large, multicenter, cross-sectional survey in China
ABSTRACT
Background:
Previous studies have shown that electrocardiographic (ECG) alarms have high sensitivity and low specificity, have underreported adverse events, and may cause NICU staff fatigue or alarm ignoring. Moreover, prolonged noise stimuli in hospitalized neonates can disrupt the development of the auditory cortex and cause neurological disorders.
Objective:
To conduct a comprehensive nationwide, multicenter, large-sample cross-sectional survey to identify current practices and investigate the decision-making requirements of healthcare providers regarding ECG alarms.
Methods:
We conducted a nationwide, cross-sectional survey of NICU staff working in Grade III Level A hospitals in 27 Chinese provinces to investigate current clinical practices, perceptions, decision-making processes, and decision-support requirements for clinical ECG alarms. A comparative analysis was conducted on the results using the chi-square, Kruskal–Wallis, or Mann–Whitney U tests.
Results:
In total, 1019 respondents participated in this study. NICU staff reported experiencing a significant number of nuisance alarms and negative perceptions as well as practices regarding ECG alarms. Physicians had more negative perceptions than nurses, and regulated physicians had the highest mean score for alarm system experience dimensions. The mean difficulty score for the decision-making about ECG alarms were 2.96±0.27 out of 5. A total of 70.07% (n=714) of the respondents reported difficulty or great difficulty in handling alarms after they occurred, while 62.32% (n=635) reported difficulty in resetting or modifying alarm parameters. Intelligent module-assisted decision support systems were perceived as the most popular form of decision support.
Conclusions:
This study highlights the negative perceptions and strong decision-making requirements of NICU staff related to ECG alarm handling. Healthcare policymakers must draw attention to the decision-making requirements of such staff and provide adequate decision support in different forms. Clinical Trial: ClinicalTrials.gov MR-31-24-015249
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