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First published July 27, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1863
Journal of the American Medical Informatics Association 2005;12(6):589-595
© 2005 American Medical Informatics Association

A more recent version of this article appeared on November 1, 2005
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Submitted on April 30, 2005
Accepted on July 12, 2005

Enhanced Notification of Critical Ventilator Events

R. Scott Evans MS, PhD1*, Kyle V. Johnson BS2, Vrena B. Flint RRT, MBA3, A. Tupper Kinder BS4, Charles R. Lyon RRT, Ms5, William L. Hawley AS4, David K. Vawdrey BS, MS6, and George E. Thomsen MS, MD7

Affiliation of the authors: 1 Department of Medical Informatics, LDS Hospital, Intermountain Health Care, Department of Medical Informatics, University of Utah School of Medicine, Salt Lake City, UT ; 2 Department of Medical Informatics, LDS Hospital, Intermountain Health Care, Salt Lake City, UT ; 3 Department of Respiratory Care, Intermountain Health Care, Salt Lake City, UT; 4 Department of Medical Informatics, LDS Hospital, Intermountain Health Care, Salt Lake City, UT; 5 Department of Information Services, Intermountain Health Care, Salt Lake City, UT; 6 Department of Medical Informatics, University of Utah School of Medicine, Salt Lake City, UT; 7 Department of Pulmonary and Intensive Medicine, Intermountain Health Care, Salt lake City, UT

* To whom correspondence should be addressed.

Mechanical ventilators are designed to generate alarms when patients become disconnected or experience other critical ventilator events. However, these alarms can blend in with other accustomed sounds of the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. We developed a system to monitor critical ventilator events through our existing hospital network. Whenever an event is identified, the new system takes control of every computer in the patient's intensive care unit and generates an enhanced audio and visual alert indicating that there is a critical ventilator event and identifies the room number. Once the alert is acknowledged or the event is corrected, all the computers are restored back to the pre-alert status and/or application. This paper describes the development and implementation of this system and reports the initial results, user acceptance, and the increase in valuable information and patient safety.




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D. K. Vawdrey, R. M. Gardner, R. S. Evans, J. F. Orme Jr., T. P. Clemmer, L. Greenway, and F. A. Drews
Assessing Data Quality in Manual Entry of Ventilator Settings
J. Am. Med. Inform. Assoc., May 1, 2007; 14(3): 295 - 303.
[Abstract] [Full Text] [PDF]


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