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Alarm fatigue in healthcare, medical device interoperability

Nearly every medical device in modern hospitals is outfitted with an alarm – patient monitors, infusion pumps, ventilators, pulse oximeters, sequential compression devices, beds, and more. The auditory and visual alarms in medical equipment are meant to enhance safety and save lives by alerting nurses of patient vital sign abnormalities. In practice, however, alarms contribute to multiple problems in hospitals, including “alarm fatigue.” Clinicians and patients are bombarded with thousands of alarms daily, while only 1% of them are actually valid. Caregivers become overloaded and desensitized to the constant alarm noises and can easily miss critical events, which, in the worst-case scenario, can cost patients’ lives.

This article discusses the nature of the alarm fatigue phenomenon and its influence on healthcare as well as a way to address it by ensuring medical device interoperability with a new IEEE 11073 SDC standard.

A Brief History of Alarm Fatigue

The term alarm fatigue was coined in 2004, when The Joint Commission, a US-based non-profit hospital accreditation organization, declared improving clinical alarm effectiveness as a standard for hospitals. However, the history of the problem dates back to 1974, when the Emergency Care Research Institute (ECRI) published its first report on an ignored alarm signal of a hypothermia machine that resulted in serious patient burns. According to the report, the alarm light flashed continuously until the patient’s temperature reached the desired value, but because of the constant flashing during a normal phase of the warming process, the alarm was ignored during a critical event.

In the past 30 years, the number of medical devices generating alarms has risen from about 10 to nearly 40, while each medical device can emit up to 40 different noises. In 1983, about six alarms could be associated with each patient in an ICU, and by 2011, this number had increased to over 40. The alarm-related risks skyrocketed, leading to dramatic consequences. The United States Food and Drug Administration (FDA) received 862 death reports associated with medical device alarms in a seven-year span, ending in 2012. The issue has become so critical that in 2008, the ECRI started including alarm fatigue on its list of Top 10 Health Technology Hazards. In 2020, alarm, alert, and notification overload ranked sixth in hazard status.

Actionable and Non-actionable Alarms

For today’s hospitals, alarm overload is only a part of the problem. The worst part is that the vast majority of these alarms are non-actionable (technical, nuisance, or false). One survey showed that more than 85% of all alarms in a hospital unit were false. According to another survey, a children’s hospital reported 5,300 alarms in a day, 95% of which were false. In 2019, researchers found that 80–99% of hospital alerts do not require clinical intervention. Non-actionable alarms distract clinicians’ attention needlessly and cause desensitization to the medical device signals, including actionable, valid alarms, that require an instant response. Failure to respond to a valid alarm can lead to delayed treatment and patient harm and may potentially be life threatening.

Negative Impact on Doctors and Patients

In fact, alarm fatigue is a featured problem in many industries, including mining, construction, transportation, and nuclear power. In healthcare, however, the issue has become especially significant because it affects not only hospital staff but also patients and their families. The shocking statistics might be inconvenient, but the truth is that the problem cannot be disregarded. A study at a large academic medical center demonstrated that, in one week, the hospital experienced at least 74,535 alarms. According to a National Public Radio story, Boston Medical Center’s cardiac care unit was sounding 12,000 alarms a day. In another story that appeared in The Washington Post, Johns Hopkins Hospital’s ICU unit tallied 771 alarms per bed each day, while about 80% of them were for low-priority conditions.

It is no wonder that caregivers exposed to thousands of alarms each day tend to perceive them as an annoying noise in the background. Clinicians with alarm fatigue are more likely to ignore or have trouble distinguishing between alarms, which compromises patient safety and effectiveness of care. In 2009–2012, 98 adverse events were recorded in the United States due to an incorrect or delayed reaction to an alarm, including 80 that ended in the death of a patient. Combined with other hospital noises, alarms may be a reason for reduced productivity, cognitive stress, anxiety, and burnout.

At the same time, a cacophony of alarms undermines patients’ ability to rest, heal, and recover. Excessive noise is associated with the development of ICU psychosis, hospitalization-induced stress, sleep deprivation, increased pain sensitivity, depressed immune system, high blood pressure, and poor mental health. There have been cases when nurses silenced alarms or turned them off completely because the beeping was too disturbing for both patients and staff, even though it put patient safety at risk. In some of these cases, unfortunately, it was fatal for patients. Moreover, multiple alarms cause constant unease for patients’ families and prevent them from providing the emotional support needed for proper healing.

Medical Device Interoperability to Reduce Alarm Fatigue

In 2020, the global COVID-19 pandemic became a catalyst for a booming demand for healthcare services. Clinically efficient and cost-effective patient care is now more important than ever. The world urgently needs a solution to alarm fatigue, but no one has a silver bullet. Recent studies on alarm fatigue focus on the creation of alarm committees, alarm management programs, smart monitors, noise reduction strategies, standardized alarm tones, and interactive communication methods. Hospitals spend millions on programs to vary medical device signals, minimize false alarms, and mitigate alarm fatigue risk. Medical device manufacturers try to address the problem by developing intelligent alarm systems. However, alarm fatigue remains a major issue for the ICU environment.

Today, every healthcare facility setting is different and typically not a mono-branded environment. Some manufacturing companies provide central stations to aggregate alarms of their medical devices and optimize alerts for the medical and nursing staff. However, it only partially helps, as the station usually collaborates with the same brand devices, encouraging the hospital to equip its ICU with mono-branded devices. Hospitals need a brand-agnostic center to collect all medical device alarms in one place and manage them in a single format yet not be bounded to one manufacturer. Interoperability and seamless networking of the medical equipment would allow hospital systems to analyze a mix of alarms coming from various devices and alert clinicians only when care is actually needed.

Luckily, new opportunities arise in the industry, one of which is a new IEEE 11073 SDC (Service-Oriented Device Connectivity) standard developed by the OR.NET e.V. association. SDC complements the healthcare IT standards landscape that typically uses HL7 v2, HL7 FHIR, and DICOM by ensuring medical device interoperability. SDC allows bidirectional or device-to-device communication enabling highly acute environments to operate in a safe and secure mode. The standard addresses the most common device-related challenges healthcare facilities face today: device control, data visualization, automation, data analytics, and alarm fatigue.

Hospital operators and medical device manufacturers in Europe, the U.S., Canada, and Japan are adopting the new SDC standard for smarter and safer healthcare. Download our free whitepaper to discover the challenges that occur while converting legacy systems into SDC and learn more about Auriga’s solution development experience in ensuring medical device interoperability with hospitals’ legacy systems. As a member of the OR.NET e.V. association, committed to international standardization and manufacturer-independent medical device networking, we are sure that this whitepaper will help you investigate the challenges and mitigate the potential risks beforehand.

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