False Alarm Reduction

Noise levels in hospitals have been rising for decades and are far higher than guideline values established by the World Health Organization. Alarm safety is one of healthcare’s most high-profile and intractable problems. A phenomenon known as “alarm fatigue”, including  limited capacity to identify and prioritize alarm signals, has led to delayed or failed alarm responses and deliberate alarm de-activations. Alarm fatigue has been implicated in patient deaths. It has been reported that between 200 and 566 patient deaths have resulted between 2005 and 2008; these numbers are likely to be underestimates.

Many factors contribute to alarm fatigue, but perhaps most significant is a false alarm rate as high as 83-85%; these large numbers of clinically irrelevant signals directly contribute to staff desensitization.  In addition, high background noise levels in critical care and variable acuity units and in operating rooms contribute to alarm response failures by further increasing the cognitive load on staff, escalating distraction and irritability, and complicating discernment, attribution and communication. 

Clinicians and managers can take steps to minimize nuisance alarms and maximize the safety and effectiveness of monitors. There are multiple levels of influence and opportunities for system intervention and innovation to facilitate timely alarm responses. These include addressing the broader acoustic context, clinician responsibility, deployment and teamwork training, threshold-setting guidelines, improved user interfaces, and algorithms balancing 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. Alarm fatigue solutions requires regulators, manufacturers and clinical leaders to recognize the importance and context of human factors and staff behavior.