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I. Bostan
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Alarm fatigue describes the desensitization, reduced alarm response, and negative emotions experienced by ICU nurses due to the excessive number of alarms generated by patient monitoring systems. Although alarms are intended to prompt action, high numbers of non-actionable alarms undermine nurse responsiveness and pose risks to patient safety. This study builds on previous research of the authors exploring the characteristics of ICU nurses as users of the system, system features of patient monitors, and alarm load across different ICU types. In this study, we synthesized previous findings into research insights. We conducted a multi-disciplinary workshop using a sound-driven design approach with diverse stakeholders, including ICU nurses, doctors, industry experts, designers, and researchers. Previous research insights were used to stimulate discussion and develop design directions aimed at mitigating alarm fatigue and supporting ICU nurse needs. The outcomes of this workshop produced actionable solution bundles that consolidate previous insights and introduce novel approaches, offering a holistic and collaborative perspective to mitigating alarm fatigue.
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Alarm fatigue describes the desensitization, reduced alarm response, and negative emotions experienced by ICU nurses due to the excessive number of alarms generated by patient monitoring systems. Although alarms are intended to prompt action, high numbers of non-actionable alarms undermine nurse responsiveness and pose risks to patient safety. This study builds on previous research of the authors exploring the characteristics of ICU nurses as users of the system, system features of patient monitors, and alarm load across different ICU types. In this study, we synthesized previous findings into research insights. We conducted a multi-disciplinary workshop using a sound-driven design approach with diverse stakeholders, including ICU nurses, doctors, industry experts, designers, and researchers. Previous research insights were used to stimulate discussion and develop design directions aimed at mitigating alarm fatigue and supporting ICU nurse needs. The outcomes of this workshop produced actionable solution bundles that consolidate previous insights and introduce novel approaches, offering a holistic and collaborative perspective to mitigating alarm fatigue.
The expansion of human lifespan has increased the demands for healthcare services. Meeting these demands requires healthcare to evolve and be more efficient. Rapi dly advancing technology plays a crucial role in this evolution by automating tasks and supporting healthcare providers in their workflow. This requires a symbiotic collaboration between humans and digital systems. On the human side, healthcare providers understand the clinical context and are highly specialized in integrating information from several sources. Yet, they face limits in attention span and workload capacity. On the digital side, patient monitoring systems operate tirelessly and with precision, yet they lack the ability to interpret the clinical context of information. Consequently, effective patient care relies on each side playing their specific roles....
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The expansion of human lifespan has increased the demands for healthcare services. Meeting these demands requires healthcare to evolve and be more efficient. Rapi dly advancing technology plays a crucial role in this evolution by automating tasks and supporting healthcare providers in their workflow. This requires a symbiotic collaboration between humans and digital systems. On the human side, healthcare providers understand the clinical context and are highly specialized in integrating information from several sources. Yet, they face limits in attention span and workload capacity. On the digital side, patient monitoring systems operate tirelessly and with precision, yet they lack the ability to interpret the clinical context of information. Consequently, effective patient care relies on each side playing their specific roles....
Customizing ICU patient monitoring
A user-centered approach informed by nurse profiles
Intensive Care Unit (ICU) nurses are burdened by excessive number of false and irrelevant alarms generated by patient monitoring systems. Nurses rely on these patient monitoring systems for timely and relevant medical information concerning patients. However, the systems currently in place are not sensitive to the perceptual and cognitive abilities of nurses and thus fail to communicate information efficiently. An efficient communication and an effective collaboration between patient monitoring systems and ICU nurses is only possible by designing systems sensitive to the abilities and preferences of nurses. In order to design these sensitive systems, we need to gain in-depth understanding of the user group through revealing their latent individual characteristics. To this end, we conducted a survey on individual characteristics involving nurses from two IC units. Our results shed light on the personality and other characteristics of ICU nurses. Subsequently, we performed hierarchical cluster analysis to develop data-driven nurse profiles. We suggest design recommendations tailored to four distinct user profiles to address their unique needs. By optimizing the system interactions to match the natural tendencies of nurses, we aspire to alleviate the cognitive burden induced by system use to ensure that healthcare providers receive relevant information, ultimately improving patient safety.
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Intensive Care Unit (ICU) nurses are burdened by excessive number of false and irrelevant alarms generated by patient monitoring systems. Nurses rely on these patient monitoring systems for timely and relevant medical information concerning patients. However, the systems currently in place are not sensitive to the perceptual and cognitive abilities of nurses and thus fail to communicate information efficiently. An efficient communication and an effective collaboration between patient monitoring systems and ICU nurses is only possible by designing systems sensitive to the abilities and preferences of nurses. In order to design these sensitive systems, we need to gain in-depth understanding of the user group through revealing their latent individual characteristics. To this end, we conducted a survey on individual characteristics involving nurses from two IC units. Our results shed light on the personality and other characteristics of ICU nurses. Subsequently, we performed hierarchical cluster analysis to develop data-driven nurse profiles. We suggest design recommendations tailored to four distinct user profiles to address their unique needs. By optimizing the system interactions to match the natural tendencies of nurses, we aspire to alleviate the cognitive burden induced by system use to ensure that healthcare providers receive relevant information, ultimately improving patient safety.
Annoyance by Alarms in the ICU
A Cognitive Approach to the Role of Interruptions by Patient Monitoring Alarms
Nurses rely on patient monitoring systems for care delivery in ICUs. Monitoring systems communicate information to nurses and alert them through audiovisual alarms. However, excessive numbers of alarms often interrupt nurses in their tasks, and desensitize them to alarms. The affective consequence of this problem is that nurses are annoyed and feel frustration towards monitoring alarms. This situation leads to stress on nurses and threatens patient safety. Literature on sound annoyance distinguishes between annoyance induced by bottom-up (perceptual) and top-down (cognitive) processing. Extensive research on perceptual annoyance informs us on how to alleviate the problem by better sound design. However, addressing the cognitive aspect requires a broader understanding of annoyance as a construct. To this end, in this paper we distinguish between the annoyance induced by sensory unpleasantness of alarm sounds, and annoyance induced by frequent task interruptions. We present a conceptual framework in which we can interpret nurses’ annoyance by monitoring alarms. We further present descriptive analysis of the occurrence frequency of patient monitoring alarms in a neonatal ICU to illustrate the current state with regards to alarms. We aim to support nurses’ organizational well- being by providing an alternative hypothesis to explaining nurses’ affective states caused by auditory alarms. Future research can benefit from this paper through understanding of the context and familiarizing with the cognitive processes relevant to processing of patient monitoring alarms.
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Nurses rely on patient monitoring systems for care delivery in ICUs. Monitoring systems communicate information to nurses and alert them through audiovisual alarms. However, excessive numbers of alarms often interrupt nurses in their tasks, and desensitize them to alarms. The affective consequence of this problem is that nurses are annoyed and feel frustration towards monitoring alarms. This situation leads to stress on nurses and threatens patient safety. Literature on sound annoyance distinguishes between annoyance induced by bottom-up (perceptual) and top-down (cognitive) processing. Extensive research on perceptual annoyance informs us on how to alleviate the problem by better sound design. However, addressing the cognitive aspect requires a broader understanding of annoyance as a construct. To this end, in this paper we distinguish between the annoyance induced by sensory unpleasantness of alarm sounds, and annoyance induced by frequent task interruptions. We present a conceptual framework in which we can interpret nurses’ annoyance by monitoring alarms. We further present descriptive analysis of the occurrence frequency of patient monitoring alarms in a neonatal ICU to illustrate the current state with regards to alarms. We aim to support nurses’ organizational well- being by providing an alternative hypothesis to explaining nurses’ affective states caused by auditory alarms. Future research can benefit from this paper through understanding of the context and familiarizing with the cognitive processes relevant to processing of patient monitoring alarms.