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Response

Thank you for your thoughtful critique of our article¹ associated with clinical alarms. Your point about "safe staffing" continues to be a major concern in the United States, especially because the nurse workforce continues to decrease due to aging, alternate career opportunities for women, and governing issues associated with the hospital work environment.

In fact, the US government recently predicted that, by 2020, nurse and physician retirements will contribute to a shortage of approximately 24 000 doctors and nearly 1 million nurses.² These workforce shortage projections have been built around the current healthcare system, which suggests that health industry leaders need to make changes in the work-force environment.

However, you should note that our survey ranked "inadequate staff to respond to alarms as they occur" as the fourth most important issue in approving alarms. Although the survey stated that staffing was not the key issue, we all know that inadequate critical care staffing is often reported. The study points to recommendations for improved care management and use of newer technologies, such as smart alarm integrators and annunciators, for which clinicians needn’t be there to hear the alarm.

The Joint Commission reported 23 deaths related to ventilator alarms and mentioned inadequate training (87%) as the prime staffing issue, with 35% of the deaths related to inadequate staffing (root cause analysis).³ The recommendations of the Joint Commission and the American Association of Respiratory Care do not state the need for 1:1 ratios for nursing care of ventilated patients; they recommend only "reviewing staffing process to ensure effective staffing for ventilator patients at all times."

Alarms are not foolproof, of course, so staff diligence and direct observation are key ingredients for improving patient care. Ultimately, a well-designed alarm system—including care management, smart device design, use of assistive technologies, and appropriate healthcare environments—can improve patient care where critical alarms are used.

Perhaps such technologies can assist the current situation, in which there is a clear nursing shortage.

FINANCIAL DISCLOSURES
None reported.

REFERENCES

1. Korniewicz DM, Clark T, David Y. A national online survey on the effectiveness of clinical alarms. Am J Crit Care. 2007;17(1):36–41.
2. Florida Hospital Association. Healing the healthcare staffing shortage. https://www.signup4.net/public/ap.aspx?EID=MEDI26E&OID=50. Accessed February 5, 2008.
3. The Joint Commission Web site. Preventing ventilator-related deaths and injuries. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_25.html. Accessed February 5, 2008.[Abstract/Free Full Text]

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Korniewicz, D. M. Articles by Clark, T. Search for Related Content PubMed Articles by Korniewicz, D. M. Articles by Clark, T.