Title : Optimizing telemetry alarm management workflow to reduce alarm fatigue
Abstract:
This initiative aimed to develop and evaluate a standardized centralized telemonitoring workflow to improve telemetry alarm response times, ensure meaningful alarms reached appropriate caregivers, reduce unnecessary alarm volume, and improve staff satisfaction. Alarm fatigue remains a critical patient safety issue in acute care, contributing to desensitization, delayed responses, and disrupted care. Aligning with the 2025 National Patient Safety Goals (NPSG.06), this project focused on reducing non-actionable alarms and improving the delivery of clinically meaningful alerts. A multi-month, iterative pilot was conducted in a high-acuity Cardiac Intensive Care Unit (CICU). Key methods included analysis of alarm data to identify high-frequency and low-value alarms, refinement of alarm thresholds, and implementation of targeted alarm suspension to allow brief physiologic self-correction before escalation. A redesigned, standardized centralized telemonitoring workflow was deployed, featuring priority-based alerting and clearer routing of alarms. Outcomes were assessed using alarm volume trends, response times, suspension rates, acknowledgment rates, and staff feedback collected through surveys and daily debriefings. Pre-implementation analysis revealed several safety and efficiency concerns: high alarm volumes, redundant alarm distribution to multiple caregivers, unclear ownership and loop closure, repeated alarm escalation without adequate response time, and low acknowledgment rates—indicating desensitization and workflow inefficiencies. Following implementation, telemetry alarms were reduced by approximately 40%–60% beginning January 2025, with sustained reductions observed through December 2025. The new workflow improved alarm routing, reduced redundancy, and enhanced the signal-to-noise ratio, resulting in a more manageable and actionable monitoring environment. Alarm acknowledgment increased by approximately 50%, reflecting improved engagement and loop closure. Importantly, these improvements were achieved while maintaining patient safety as the primary focus. Given the success in the CICU, the standardized workflow was scaled across all 12 facilities within the health system. Three months after enterprise-wide implementation, overall telemetry alarms had decreased by 43%. In conclusion, alarm fatigue remains a significant patient safety risk. This project demonstrates that standardized, data-driven centralized telemonitoring workflows can substantially reduce alarm burden, improve caregiver response and engagement, and support safer, more effective care delivery in high-acuity environments.
