B-po02-184 use of a novel rank order score to prioritize detection of lethal arrhythmias in the secondary, off-site monitoring of hospitalized patients

Off-site secondary monitoring has emerged for hospitalized patients to capture critical missed events. Evaluate the total priority risk score (TPRScore) to detect and prioritize lethal arrhythmias (LA) over non-lethal alarms (NLA) among non-ICU hospitalized patients. Retrospective analysis of patients at Cleveland Clinic main campus and community hospitals for LA capture at TPRScore ≥50 triggering monitor technician (MT) review, including ICU transfer and death, plus mean and quartile comparisons for the max event-associated TPRScores. Among 1,537 patients (64 ± 16 yrs, 42% female), LA occurred in 585 (38.1%) including ventricular tachycardia/fibrillation (n=222, 14.4%), and asystole/severe bradycardia (n=363, 23.6%). NLA occurred in 921 (59.9%). Mean TPRScore was higher among patients with LA (550 vs. 260; p<0.001), and lower among NLA (NLA: 268 vs. 523; p<0.001). Quartile analysis demonstrated the proportion of patients experiencing LA steadily rose (Q1: n=0 (0%), Q2: n=44 11.4%, Q3: n=250, 66%, Q4: n=291, 75.8%, p<0.001) including LA-associated ICU transfers (Q1: n=0, (0%), Q2: n=1, (1%), Q3: n=3, (4%), Q4: n=8, (11%), p=0.001). No LA were missed at TPRScore ≥50 (LA n=585/1485, 39% vs. 0/52, 0%; p<0.01), including LA-associated ICU transfers (n=12/12,100%) at median 1.0 hrs (range 0.3-6.5 hrs) and death (n=5/12, 42%). No LA-associated ICU transfers or death occurred below this threshold. The TPRScore prioritized LA over NLA without any missed events at the triggered review threshold. Patients with LA, including those requiring ICU transfer, were significantly associated with higher quartile TPRScores.