Acoustical Presentation Urges Rethinking of Alarm Use in Hospitals
October 11th, 2016
SALT LAKE CITY – Clinical alarm errors occur in U.S. hospitals more than 8 million times a day, with 90% of clinical alarms resulting in no action.
No wonder that hospital alarms are currently ranked as the "top medical technology hazard" within the United States, according to a session at the recent Acoustical Society of America's Spring 2016 Meeting.
A presentation by consultant Ilene Busch-Vishniac reports that the 480,000 patients in U.S. hospitals each generate an average of about 135 clinical alarms per day. Errors occur when alarms either fail to sound or go off but receive no response, according to the model, which was based on several recent studies of hospital alarms.
"In each case, alarms reflect a medically urgent situation or they don't," Busch-Vishniac explained. "For each situation, the response is either appropriate or inappropriate. This means there are eight possible scenarios associated with alarms, so we can estimate how often each occurs and how often errors occur."
In current studies, "the fraction of alarm errors reported as adversely affecting patients is extremely low," she added. "But alarms often don't serve the purpose for which they're intended: to alert medical staff to urgent situations. Instead, alarms go off all the time and rarely indicate truly urgent situations. And while the focus has been on ensuring that the hospital staff responds to all alarms, studies show that it's more common for alarm errors to occur because alarms that should sound fail to do so. This means that responding to all alarms won't eliminate most alarm errors."
While some research has suggested that hospital alarms negatively affect patient recovery, she said insufficient data is available at this time to really answer the question.
"Our work suggests that it's time to rethink alarm strategies entirely, with a goal of reducing the number of alarms to those that truly reflect urgent situations while balancing the need to alert staff with the need to establish quieter hospital environments," she added.
The study notes that data on the effects of alarm errors indicate about 200 related deaths per year and fewer than 500 adverse effects per year.
“A compelling conclusion from this data is that clinical alarms in hospital are very inefficient and ineffective tools for monitoring medical emergencies,” Busch-Vishniac said. “Much attention has been dedicated to alarms recently, with the general goal of improving response to alarms in order to ensure no medical emergency is missed. While this work is of immediate use and is vitally important to the operation of the modern hospital, it focuses on minor changes to the existing systems rather than on trying to design the optimum system for the future.”
She suggested comparing outcomes of patients when alarms sound within their area vs. when alarms are intentionally muted and sent to staff via pagers or cell phones, adding, "This will help to establish whether alarms potentially harm patients, as well as save lives.”
Other areas requiring exploration, she said, include when alarms should sound, which sounds should be used, and ways to make alarm systems more intelligent by combining information from multiple medical devices.