The advanced technology used in these surveillance systems has provided a significant amount of physiological data at low cost while being particularly helpful by facilitating the monitoring of critically ill patients to identify deviations of vital signs (e.g., heart rate, respiratory rate, blood pressure, and pulse oximetry) from normal ranges. These alerts are relayed from patient monitoring devices, which provide continuous flow of vital sign data with a high degree of sensitivity. To help nurses and other staff cope with their many responsibilities, various audible and visual alerts have been implemented to prompt immediate response and clinical assessment of patients. Multiple simultaneous interactions between patients, families, and health-care staff may create an added element of chaos. Hospital patient care units tend to be high-paced and potentially unpredictable environments, with complex workflows. Among contributing factors are also high staff workload, long shift hours, and work environments with high noise levels, all of which contribute to the “desensitization effect” associated with AF. It is defined as the decrease of clinician response caused by excessive alarms, sensory overload, and desensitization, in addition to other occupational and environmental variables. One such consequence, and the primary topic of this chapter, is the phenomenon of alarm fatigue (AF). Beyond the concept of “false alarm,” suboptimal implementation of clinical monitoring systems can have much more profound and potentially dangerous consequences. Despite tremendous progress over the past few decades, the “perfect solution” remains elusive, with focus being placed primarily on clinical indications and appropriateness of use for the existing equipment and monitoring frameworks. Highly reliable, precise, user-friendly, and cost-effective clinical alarm systems are critical to efficient functioning of health-care facilities. Targeted quality improvement initiatives and staff training, as well as the proactive incorporation of technological improvements, are the best approaches to address key barriers to the optimal utilization of clinical alarms, AF reduction, better patient care, and improved provider job satisfaction. Ultimately, consequences of AF include missed alerts of clinical significance, with substantial risk for patient harm and potentially fatal outcomes. When poorly optimized, clinical alarm activity can affect patient safety and may have a negative impact on care providers, leading to inappropriate alarm response time due to the so-called alarm fatigue (AF). Major opportunities for improvement in both equipment design and monitor utilization have been identified, including the presence of excessive false and nuisance alarms. Unfortunately, even the most modern patient monitoring systems carry significant drawbacks that limit their effectiveness and/or applicability. Key considerations inherent to this area of concern include patient safety, reliability, ease of use, and cost containment. Although the technology is so new that it is rarely known and has not been applied to routine practices in hospitals, it shows good prospects for critical care, oxygen therapy, and intraoperative monitoring.As the demand for health-care services continues to increase, clinically efficient and cost-effective patient monitoring takes on a critically important role. ORI can provide an early warning before saturation begins to decrease and expands the ability to monitor the human body’s oxygenation status noninvasively and continuously with the combination of pulse oximetry so as to avoid unnecessary hyperoxia or unanticipated hypoxia. A systematic literature search of PubMed, MEDLINE, Google Scholar, and ScienceDirect was performed with the keywords of "oxygen reserve index," "ORI," "oxygenation," "pulse oximetry," "monitoring," and "hyperoxia." Original articles, reviews, case reports, and other relevant articles were reviewed. This review aimed to discuss its clinical utility, prospect and limitations. The oxygen reserve index (ORI) is a new technology that provides real-time, non-invasive, and continuous monitoring of patients' oxygenation status.
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