Anyone who has worked in a hospital knows that it can be a noisy place. Staff at a 15-bed unit at Johns Hopkins Hospital documented an average of 942 alarms each day – or 1 every 90 seconds (no wonder that their new high-tech hospital prioritized noise reduction to improve patient comfort). While some of these alarms are critical, many are false alarms or alarms to indicate the status of the machine itself and not the patient. Such over-stimulation can potentially lead to desensitization, a phenomenon known as “alarm fatigue.” It’s a workflow problem with dire consequences: alarm fatigue resulted in over 200 deaths nation-wide in the second half of the 2000s.
In order to learn more about the problem of alarm fatigue and what types of medical technology solutions are around the corner we spoke with the Dr. Joe Frassica, the Chief Medical Information Officer at Philips Healthcare.
Shiv Gaglani, Medgadget: What is alarm fatigue and why is it such a problem?
Joe Frassica, MD: In hospitals today, the medical device landscape can be noisy and disruptive. Alarms sounding from devices connected to patients are intended to alert clinicians of patients’ conditions that may or may not require immediate intervention.
Too many auditory alarm signals in the busy clinical environment not only contributes to staff interruption and patient/staff dissatisfaction, but can overwhelm clinicians and medical staff, leading to alarm fatigue. As a result of alarm fatigue, medical staff and clinicians dismiss alarms, turn them off or unintentionally ignore them, and therefore put patients’ safety at risk.
Alarm fatigue was cited in an ECRI Institute report in 2011 as the number one hazard faced by hospitals. The report said that in a hospital setting, the frequency of alarms poses a risk that some hospital staff becoming desensitized to the constant beeps and, in the worst cases, lowering the volume too much.
Alarm fatigue is a complex healthcare issue. Philips works alongside academics, clinicians, regulators and other manufacturers to develop solutions that reduce alarm-related adverse events.
Medgadget: How did you get interested in this problem, and what is your background in medical informatics/technology?
Frassica: Prior to joining Philips Healthcare as the Chief Medical Information Officer for its Patient Care and Clinical Informatics (PCCI) business, I served as Chief Medical Information Officer and clinical informatics leader for Miami’s Jackson Health System, a six-hospital public health system, along with its integrated health care delivery network. In addition to managing the clinical informatics direction for the Jackson hospital system, I was responsible for clinical oversight of the roll-out of a new core enterprise EMR with CPOE (Computerized Physician Order Entry), documentation, and decision support; implementation of system-wide PACS and Radiology Information Systems; and updates of the system’s best of breed Anesthesia Information System.
I currently serve on the Association for the Advancement of Medical Instrumentation’s (AAMI) Health Technology Safety Institute’s (HTSI) Alarm Management Committee. HTSI is a community of Healthcare leaders from industry, academia and clinical medicine that is dedicated to ensuring the safety of medical technology. My work at Philips and with AAMI/HTSI and my experience as a clinical informatics leader have all contributed to my drive to help improve the alarm management landscape.
Medgadget: Can you describe the MIMIC II Database and how it has provided insight into the problem of alarm fatigue?
Frassica: The MIMIC II research database (Multiparameter Intelligent Monitoring in Intensive Care) was created by obtaining data from a hospital’s ICU information systems, hospital archives and other external data sources.
The MIMIC II research database is notable for three factors: it is publicly and freely available; it encompasses a diverse and very large population of ICU patients; and it contains high temporal resolution data including lab results, electronic documentation, and bedside monitor trends and waveforms. The database can support a diverse range of analytic studies spanning clinical decision-rule improvement and electronic tool development, helping to target the causes of alarm fatigue and ultimately solving the issue.
Medgadget: What innovations has Philips implemented (or is currently working on) to address the problem of alarm fatigue?
Frassica: Philips has been involved in solving issues related to alarm fatigue since 1998, when it co-convened the first ISO TC121/SC3 – IEC SC62A Joint Working Group for Alarm Systems. The working group is made up of experts from academic, clinical and industry backgrounds who review and evaluate issues surrounding clinical alarms. Additionally, as I mentioned above, I joined the Association of Advancement of Medical Instrumentation’s Health Technology Safety Committee to help solve the issue of alarms management. AAMI plans to support the FDA and the Joint Commission on a strategic approach to this issue.
Since its convening of the first Joint Working Group for Alarm Systems, Philips has continued to work with academics, clinicians and manufacturers to develop solutions that integrate alarm systems to address the issue of alarm fatigue.
Designed for busy clinical environments, Philips’ alarm systems are helping hospitals achieve better patient outcomes, improve clinical workflows, increase patient and staff satisfaction and maintain a less hectic environment. Additionally, Philips provides advanced technology, consulting services, training and access to ongoing research, while playing an active role in the development of alarm standards.
Philips offers the following solutions to address the issue of alarm fatigue:
- IntelliVue Information Center iX: supports hospital research on alarm management and sentinel events. The Alarm Audit Log allows hospitals to take a holistic view of alarm management and analyze alarm data in order to optimize alarm limits and reduce clinically non-actionable (aka “nuisance”) alarms. The information can also be used to understand the total volume of alarms from different rules and how those rules may interact with each other.
- IntelliVue patient monitors’ clinical decision support tools: help clinicians spot subtle signs of patient deterioration sooner. Users can adapt their systems to fit their workflow, reduce auditory interruptions and support the delivery of optimal patient care.
- Graphical decision support tools such as ST Map, Horizon Trends and Histograms: turn data into clinically relevant information. Data from multiple clinical parameters are integrated into one intuitive view, enabling clinicians to spot trends in a patient’s condition at one glance and without the interference of auditory alarm signals.
- Philips IntelliSpace Event Management system: gathers clinical data from various patient monitoring devices, escalates the most critical and relevant patient information, and then delivers that information to a provider’s handheld device of choice for clinician response. This solution provides hospitals with a smarter and more efficient way to manage alarms.
- Philips Healthcare Consulting: offers clinical process and technical expertise to improve alarm management and prevent alarm fatigue. Philips structures and streamlines alarm management capabilities to enhance health care providers’ people, process and technology management.
Medgadget: Do you have evidence that these innovations are working or will work?
Frassica: Although there is no current published research on Philips’ devices specifically, Philips has partnered with MIT and others focused on research in the alarm fatigue area. An NIH (NIBIB) funded research program is focused on developing advanced ICU patient monitoring and decision support systems that will improve the efficiency, accuracy and timeliness of clinical decision-making in critical care. This includes improving overall alarms in critical care. This program is also making the one of a kind clinical database available to the world, so others can contribute in this area as well.