What is the sound of one hand clapping? If a tree falls in a forest, does it make a sound? If a healthcare alarm is in no fashion alarming, what judgement ought we make of its existence?
The authors of this study, from UCSF, compose a beautiful, concise introduction to their study, which I will simply reproduce, rather than unimpressively paraphrase:
“Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing ‘alarm fatigue’ which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload.“
We all, intuitively, know this to be true. Even the musical mating call of the ventilator, the “life support” of the critically ill, barely raises us from our chairs until such sounds become insistent and sustained. But, these authors quantified such sounds – and look upon such numbers, ye Mighty, and despair:
2,558,760 alarms on 461 adults over a 31-day study period.
Most alarms – 1,154,201 of them – were due to monitor detection of “arrhythmias”, with the remainder split between vital sign parameters and other technical alarms. These authors note, in efforts to combat alert fatigue, audible alerts were already restricted to those considered clinically important – which reduced the overall burden to a mere 381,050 audible alarms, or, only 187 audible alarms per bed per day.
Of course, this is the ICU – many of these audible alarms may, in fact, have represented true positives. And, many did – nearly 60% of the ventricular fibrillation alarms were true positives. However, next up was asystole at 33% true positives, and it just goes downhill from there – with a mere 3.3% of the 1,299 reviewed ventricular bradycardia alarms classified as true positives.
Dramatic redesign of healthcare alarms is clearly necessary as not to detract from high-quality care. Physicians are obviously tuning out vast oceans of alerts, alarms, and reminders – and some of them might even be important.
“Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients”
http://www.ncbi.nlm.nih.gov/pubmed/25338067