Electronic Health Records


Alarm simplification can avoid fatigue, boost patient safety

By Jennifer Bresnick

It’s one of those curiously depressing facts of life that we all still jump to attention every time our cell phones signal a new text message, but we unconsciously tune out sounds in the workplace that are intended to help us do our jobs better and, in the case of clinicians in the hospital setting, keep patients alive and safe.  Alarm fatigue is not a new concept for providers inundated with dings and whistles from a constantly increasing number of electronic monitoring systems, but it’s a situation that continues to have serious side effects.  A new viewpoint article in the Journal of the American Medical Association (JAMA) calls attention once again to the perils of selective hearing in the hospital.

Alarm fatigue has been labeled a top concern on a number of patient safety risk lists, including those of the ECRI Institute and the Joint Commission.  In a JAMA survey last year, 87% of physicians called EHR-based alerts “excessive,” and the Physician-Patient Alliance for Health and Safety recently said that alarm fatigue is a serious concern at 19 out of every 20 hospitals in the country.  Vineet Chopra, MD, MSc, of the University of Michigan, believes something must be done about the auditory overload plaguing nurses and physicians.

“Like many innovations, alarms were first developed to provide benefit to an exceedingly small group of high-risk patients,” Chopra explains. “Because clinical events and hemodynamic alterations often presaged harm in this population, alarms were successful at averting complications. Encouraged by these benefits, the medical community expanded this model to other low-risk populations. The consequence of this well-intentioned generalization is epitomized in the din of chirps, beeps, bells, and gongs that typify hospitals today. It is thus not surprising that concerns regarding safety have emerged, even in populations for whom these protective devices were once considered most valuable.”

Alarms are only useful when a clinician recognizes that the event it signals is a serious one, Chopra argues.  Devices that sound upon false-positive events can annoy clinicians into inappropriately muting sounds that may lead to unintentional harm to the patient when an adverse event does actually occur.  “What is needed is a complete reimagining of alarm systems from a patient-centric perspective,” he says.

Just as nurses triage patients entering the emergency room, alarms should be stratified according to priority.  Infusion pumps that beep upon completion of their task don’t necessarily indicate a high-risk situation, and the use of these noises may need to be reconsidered in order to limit ambient alerts that distract from serious issues.  “It is important to consider how and when alarms manifest, as systems that alert must be separated from those that inform,” Chopra explains. Visual notices or vibrating signals could replace loud noises while accomplishing the same goal.

Integrating alarm systems can also give clinicians a better idea of what is important and what isn’t.  “A low blood pressure alarm means little in isolation to a clinician. If, however, the blood pressure reading is also accompanied by a rapid heart rate and knowledge that these trends represent deviations from baseline, a meaningful message is created,” Chopra writes.  “This type of artificial intelligence that recognizes clinical patterns, learns ‘baselines,’ and synthesizes real-time trends to process alerts could move hospital alarms from their currently fragmented state to a more unified, patient-centered clinical monitoring model.”

Revamping alarm systems to be smarter may be the key to eliminating alarm fatigue and return the chirping chorus of the hospital bed to something more meaningful to clinicians.  “The scope and design of these systems must shift from the status quo to a biologically valid, clinically relevant, patient-centered model,” Chopra concludes. “Changes to design and implementation of alarms are necessary to improve patient safety. No longer should hospitals be alarmed and potentially dangerous.”





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