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HoF : Minimizing Alarm Fatigue for Hospital Staff in the ER

HoF : Minimizing Alarm Fatigue for Hospital Staff in the ER. Jenny Liu, MS ECE October 11, 2012. Problem Overview. Problem Statement Audible irritants (such as alarm fatigue) lower staff sensitivity and awareness in ER Scope of topic: hospital staff centric, devices Background

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HoF : Minimizing Alarm Fatigue for Hospital Staff in the ER

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  1. HoF: Minimizing Alarm Fatigue for Hospital Staff in the ER Jenny Liu, MS ECE October 11, 2012

  2. Problem Overview • Problem Statement • Audible irritants (such as alarm fatigue) lower staff sensitivity and awareness in ER • Scope of topic: hospital staff centric, devices • Background • noise irritants are associated with impaired performance in a generally stressful situation [Arvisdsson] • 91% of nurses surveyed felt that noise negatively affected them in their daily environment, contributing to stress symptoms such as irritation, fatigue, tension headaches and concentration problems. [Ryherd] • FDA regulation: trim hospital alarm fatigue (2012) • At least 216 deaths nationwide between 2005-2010 due to medical personnel not reacting to alarms • Overview • Lowered noise levels -> better communication, less error in transmission of information • Reducing patient stress -> less work for hospital staff • More opportunity cost for hospital if patients recover sooner • Factors contributes to better quality of care

  3. Measurements and Statistics • Statistics on current issue • EPA Standard for Rest and Sleep in hospitals: 45 dB • Measured: patient rooms 50-63 dB • In hospital: • paper rippling: 41-81 dB • binder opening: 40-70 dB [1] • Metrics • Quantitative • Speech Intelligibility Index (SII) • Frequency/Spectrogram of ambient sounds • Statistics of response/awareness • Qualitative • Survey of preference/reactions toward alarms by staff

  4. Designing better Alarms: Psychoacoustics Benefits of Auditory Alarms Alarm design consideration • Omnidirectional • useful when eyes are busy • Induces greater compliance • If an alarm is very important, use auditory alarm • Can’t close our ears • Frequency/Periodicity • Within hearing range and not irritant • Not heard so often to produce insensitivity • Intensity • Differ by 15 dB • Auditory masking • Heard above background • Not startle (rise time) • Not disrupt understanding of other alarms/communication • Threshold of false alarms • Sensitivity/awareness • Earcons/Spearcons • Sound like the condition they represent (Associative) • Deleting files = crushing paper

  5. Reducing Noise Pollution with Music • Reduce excess noise with efficacy of music therapy • Use of “Sound Control Center” • Study showed that music may be an alternative form to analgesia • Music selected by patient • Control group of ventilator noise • Within 30-min period, heart and respiratory rates slowed (more effectively than control) • Benefits • Avoids negative side affects • Cost of pharmaceutical

  6. Music prior to medical procedures • Music Vibration Table • Pain relief to pre-surgery • May reduce post-operative pain by preempting central sensitization of nociceptor neurons while helping to psychologically medicate pain • Applications • Orthopedics • Cardiac • Examination of infants

  7. Other solutions • Space design • Audio barrier of staff stations • Layout: reverberation time • Telemetry • Monitor via telemetry rather than bedside • Instead of overhead paging of staff • Questions?

  8. References • [1] Arvidsson O, Lindvall T. Subjective annoyance from noise compared with some directly measurable effects. Arch Environ Health 1978;33:159–66. • [2] E. Ryherd, K. PerssonWaye, and L. Ljungkvist “Characterizing noise and perceived work environment in a neurological intensive care unit,” J. Acoust. Soc. Am. 123, 747-756 (2008). • [3] Kowalczyk, Liz. FDA working to trim hospital “alarm fatigue”, March 2012, http://articles.boston.com/2012-03-26/health-wellness/31237407_1_alarms-medical-devices-maisel • [4] Boyd-Brewer, Chris, “Vibroacoustic Therapy: Sound Vibrations in Medicine”, Alternative and Complementary Therapies, October 2003, http://www.musicandlearning.com/articles_vtsvim.cfm • [5] Fausset, Cara, “Vision Signal Detection Audition”, Presentation. Feb 2012. • [6] http://www.healthcaredesignmagazine.com/article/too-noisy-heal • [7] http://www.healthcaredesignmagazine.com/article/acoustical-design-healthcare-issue-needs-be-heard • [8] Chesky, K. Patent 5035235: Music vibration table and system, 1990.

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