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Redesigning Hospital Alarms for Reliable and Safe Care

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Surgical Patient Care

Abstract

Alarms contribute significantly to noise pollution in healthcare and “alarm fatigue” limits a care provider’s capacity to identify and prioritize these signals. The exceedingly high rates of clinically irrelevant alarms and high background noise levels in clinical environments contribute to staff desensitization resulting in response failures.

Monitoring devices that process complex data should produce clinically relevant alarm signals. This chapter identifies multiple levels of influence and opportunities for system intervention and innovation to facilitate timely and reliable alarm responses. These include addressing the broader acoustic context, clinician responsibility, deployment and teamwork training, threshold-setting guidelines, improved user interfaces, and algorithms balancing alarm specificity and sensitivity. Monitoring devices that process complex data streams should produce clinically relevant alarm signals, in environments optimized for discernment and attribution, with user interfaces designed for timely interpretation, prioritization, and prompt action. Hospitals need a system-wide alarm management policy and protocols that define the alarm management strategy for alarmed medical equipment, and delineate how caregivers/nurses should respond to alarm conditions and signals. It is imperative that a human factors approach based around the hospital’s culture is used that actively engages architects, designers, acoustical engineers, facility engineering, staff, and clinicians to address alarm fatigue and the implications of the physical built environment. Involving patients in the redesign of hospital acoustic environments may improve patient experiences and satisfaction with their care.

“Even the boy who cried wolf was right about the wolf once.”

—Sherry Thomas

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Notes

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    ECRI Institute. ECRI Institute releases top 10 health technology hazards report for 2014. November 4, 2013. https://www.ecri.org/Press/Pages/2014_Top_Ten_Hazards.aspx Accessed January 3, 2014.

  2. 2.

    See Johns Hopkins Hospitals clinical alarm management policy http://hpo.johnshopkins.edu/hopkins/policies/39/11305/policy_11305.pdf?_=0.231088243942.

  3. 3.

    http://www.jointcommission.org/assets/1/18/jcp0713_announce_new_nspg.pdf.

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Authors and Affiliations

  1. Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, 5057 Woodward Avenue, Suite 13001, Detroit, MI, 48202, USA

    Paul Barach BSc, MD, MPH

  2. Department of Surgery, Ascension Saint Agnes Hospital, Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Juan A. Sanchez MD, MPA

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  1. Paul Barach BSc, MD, MPH
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  2. Juan A. Sanchez MD, MPA
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Correspondence to Paul Barach BSc, MD, MPH .

Editor information

Editors and Affiliations

  1. Department of Surgery Ascension Saint Agnes Hospital Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Juan A. Sanchez

  2. Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Paul Barach

  3. Department of Surgery Center for Healthcare Studies Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Julie K. Johnson

  4. Division of Cardiovascular Surgery Johns Hopkins All Children’s Heart Institute Johns Hopkins All Children’s Hospital, Johns Hopkins University, Saint Petersburg, FL, USA

    Jeffrey P. Jacobs

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Barach, P., Sanchez, J.A. (2017). Redesigning Hospital Alarms for Reliable and Safe Care. In: Sanchez, J., Barach, P., Johnson, J., Jacobs, J. (eds) Surgical Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-44010-1_17

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  • DOI: https://doi.org/10.1007/978-3-319-44010-1_17

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