Applying Human Factors Engineering to Address the Telemetry Alarm Problem in a Large Medical Center

Abstract

Objective Address the alarm problem by redesigning, reorganizing, and reprioritizing to better discriminate alarm sounds and displays in a hospital. Background Alarms in hospitals are frequently misunderstood, disregarded, and overridden. Method Discovery-oriented, intervention, and translational studies were conducted. Study objectives and measures varied, but had the shared goals of increasing positive predictive value (PPV) of critical alarms by reducing low-PPV alarms in the background, prioritizing alarms, redesigning alarm sounds to increase information content, and transparently conveying who initiated alarms. An alarm ontology was iteratively generated and refined until consensus was achieved. Results The ontology distinguishes five levels of urgency that incorporate likely PPV, three categories for who initiates the alarm (hospital staff, patient, or machine), whether it is clinical or technical, and clinical functions. Conclusion This unique collaboration allowed us to make progress on the alarm problem by making unintuitive leaps, avoiding common missteps, and refuting conventional healthcare approaches. Application Hospitals can consistently redesign, reorganize, reprioritize, and better discriminate alarms by priority, PPV, and content to reduce nurse response times.

Auditory Sequences Presented With Spearcons Support Better Multiple Patient Monitoring Than Single-Patient Alarms: A Preclinical Simulation

“…Considerable recent work has been done to improve the informativeness of auditory displays for healthcare, but further work is needed (Cvach, 2012; Graham & Cvach, 2010; Patterson et al, 2021). In a recent fieldwork study, Deschamps and Sanderson (2021) showed that clinicians in high dependency and critical care units (HDU/CCU) rely heavily on auditory information, despite its occasional annoyance, and they sometimes use auditory alarms beyond the scope of their intended design to help maintain situation awareness.…”

“…There may be a limit to the number of non-speech sounds that can be easily learned and discriminated, even where carefully designed auditory icons are used. There is an increasing recognition that speech alerts may have a role in patient monitoring (Fitzgerald et al, 2019; Patterson et al, 2021; Rayo et al, 2019). A recent preclinical trial showed dramatic advantages of speech alerts over auditory icon sounds for identifying the meaning of common risk categories in patient monitoring (Roche et al, 2021; Webster & Sanderson, 2021).…”

Perceptually Discriminating the Highest Priority Alarms Reduces Response Time: A Retrospective Pre-Post Study at Four Hospitals

“…There were no constraints on the alarm sound design other than creating a digital sound file because SANS is not regulated by the Food and Drug Administration, but we did take into account how our approach could be aligned with a substantial update of the medical device safety standard for FDA-approved bedside monitors (Grob, 2020). We used an ontology to guide our design (Patterson et al, 2021). The dimension where we wanted the greatest perceptual discriminability was between alarms initiated by clinical hospital staff members, patients, and automation.…”

Preliminary Evaluation of Cardiac Telemetry Technician Work in a Large Health System: Mutual Dependence and Considerations for Patient Load

“…The main benefit offered by telemetry is the increased mobility of patients while still allowing for them to be monitored for threatening changes to their vital signs (Montano & Grabowski, 2011). Unintentionally, the introduction of telemetry technology has also produced new layers of complexity to clinical work, including concerns around cardiac telemetry monitoring technician's ("teletechs") ability to maintain vigilance (Nare & Hancock, 2021), patient load and teletech' ability to quickly recognize and respond to concerning waveforms (Segall et al, 2015), and the introduction of numerous and frequent alarms to caregivers (e.g., patient care technicians, nursing assistants, and registered nurses) working in different units that have telemetry in place (Patterson et al, 2022). Though several studies have identified these concerns, most studies examining use of telemetry systems have taken place in simulated settings.…”