Anesthesia Alarms in Context: An Observational Study

Abstract

This paper surveys current work on the design of alarms for anesthesia environments and notes some of the problems arising from the need to interpret alarms in context. Anesthetists' responses to audible alarms in the operating room were observed across four types of surgical procedure (laparoscopic, arthroscopic, cardiac, and intracranial) and across three phases of a procedure (induction, maintenance, and emergence). Alarms were classified as (a) requiring a corrective response, (b) being the intended result of a decision, (c) being ignored as a nuisance alarm, or (d) functioning as a reminder. Results revealed strong effects of the type of procedure and phase of procedure on the number and rate of audible alarms. Some alarms were relatively confined to specific phases; others were seen across phases, and responses differed according to phase. These results were interpreted in light of their significance for the development of effective alarm systems. Actual or potential applications of this research include the design of alarm systems that are more informative and more sensitive to operative context than are current systems.

Sonification Supports Eyes-Free Respiratory Monitoring and Task Time-Sharing

“…Some work environments stand out because of the apparent difficulty of achieving this goal. For example, many researchers have pointed out that the anesthesiologist is poorly supported by the design of the anesthesia machine and the associated patient monitoring systems (Cook & Woods, 1996;Seagull & Sanderson, 2001;Watson, Sanderson, & Russell, 2004). The commonly noted frustration with auditory alarm systems is a symptom of the wrong information (critical boundaries rather than trends) arriving at the wrong time (when many other things may also be going wrong) and in the wrong format (an auditory format that must be silenced for work to proceed effectively).…”

Patient Monitoring Alarms in the ICU and in the Operating Room

“…Seagull and Sanderson also diff erentiated three diff erent phases in anesthesia procedures (introduction, maintenance and emergence) and found characteristic patterns of alarms and alarm reac tions in each phase [20].…”

“…Only 3 % of all alarms indicated cri tical situations [21]. However, the studies by Kestin [21] and Seagull [20] were l imited by the fact that 5 and 6 diff e rent monitors, re spectively, were used in these observational studies.…”

“…Seagull and Sanderson sur veyed perioperative alarms in diff erent surgical disciplines (arthroscopic, cardiac surgery, abdominal surgery, and neurosurgery) with 6 cases in each discipline. Th e authors found 72 % of alarms had no clinical consequences [20]. A study by Kestin et al [21] included 50 pediatric patients (1 month to 10 years o ld) in the OR of a pediatric hospital (pediatric surgery, eye surgery, dental surgery, orthopedic surgery) and also found that 75 % alarms had no therapeutic consequences (1 alarm per 4.5 minutes on average).…”

A conceptual framework to guide the design and evaluation of human interaction with information automation to support judgment

“…Such automated judgment systems have been found to be valuable, particularly as alerting systems [96], [97].…”