Out of room alarm: An alarm that (a) occurs while no clinicians are in the patient’s room or are viewing the central monitoring station, and (b) sends an automatic text message to the bedside nurse (alarms for asystole, ventricular tachycardia, ventricular fibrillation, apnea, heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), SpO2 probe off, and leads fail). The text message includes the following elements: General Electric alarm level (crisis, warning, advisory, or system), alarm type and value that triggered the alarm (such as the HR HI 190), and the date and time.

Clinical alarm: An alarm for a cardiac arrhythmia or a physiologic parameter that is outside of the range set for the patient on the bedside monitor.

Valid alarm: A clinical alarm that correctly identifies the physiologic status of the patient. Validity was based on waveform quality, signal strength indicators, and artifact conditions, referencing the monitor’s operator’s manual.

Actionable alarm: A valid clinical alarm that either (a) leads to an observed clinical intervention (such as initiating supplemental oxygen) or (b) leads to an observed consultation with another clinician (such as discussing the patient’s tachycardia with a resident) at the bedside or (c) warrants intervention or consultation for a clinical condition (such as a prolonged desaturation) but the condition was unwitnessed: occurring while no clinicians are present and resolving before any clinicians entered the room or visualized the central monitoring station.

Nonactionable alarm: An alarm that does not meet the actionable definition above, including invalid alarms such as those caused by motion artifact, alarms that are valid but nonactionable, and technical alarms.

Technical alarm: An alarm for a problem with the physiologic monitor device or associated sensors.