Listen to the Real Experts: Detecting Need of Caregiver Response in a NICU using Multimodal Monitoring Signals

Vital signs are used in Neonatal Intensive Care Units (NICUs) to monitor the state of multiple patients at once. Alarms are triggered if a vital sign is below/above a predefined threshold. Numerous alarms sound each hour which could translate into an overload for the medical team, known as alarm fatigue. Yet many of these alarms do not require immediate clinical action of the caregivers. In this paper we automatically detect moments that need an immediate response (i.e. interaction with the patient) of the medical team in NICUs by using caregiver response to the patient, which is based on the interpretation of vital signs and of nonverbal cues (e.g. movements) delivered by patients. The ultimate goal of such approach is to reduce the overload of alarms while maintaining the patient safety. We use features extracted from the electrocardiogram (ECG) and pulse oxymetry (SpO2) sensors of the patient, as most unplanned interactions between patient and caregivers are due to deteriorations. Since in our unit an alarm can only be paused or silenced manually at the bedside, we used this information as a prior for caregiver response. We also propose different labeling schemes for classification, each representative of a possible interaction scenario within the nature of our problem. We accomplished a general detection of caregiver response with a mean AUC of 0.82. We also show that when trained only with stable and truly deteriorating (critical state) samples, the classifiers can better learn the difference between alarms that need no immediate response and those that do. In addition, we present an analysis of the posterior probabilities over time for different labeling schemes, and use it to speculate about the reasons behind some failure cases.