UX & Human Factors

Rethinking Medical Device Alarms Design

By François Longpré

In the hospital, sound is omnipresent, especially in Intensive Care Unit (ICU) rooms. These are extremely noisy working environments, where medical device alarms are constantly beeping.
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Audio Credits: Youtube – How Aaron Does It – Kelly’s ICU Sounds

These alarms are accompanied by an error message. Their role is to alert medical staff to anomalies or situations that are dangerous to the patient’s health and require human intervention.
Consequently, poor alarm sound design can have disastrous repercussions in the high-risk environment of the hospital.

The Hospital: A High-Risk Environment

Alarm frequency in ICUs is notably high. Over one week, a study recorded over 2,000 alarms. with 94% being non-significant.

Due to exposure to these false alarms, medical staff may start to ignore them, increasing the risk of missing a critical one. This phenomenon, known as “alarm fatigue”, has been linked to nearly 600 deaths in the USA over the past five years, according to the FDA.

These inopportune alarms also cause stress for the patient. They interfere with sleep, and can affect recovery. Some patients who have spent extended periods in an ICU may even require treatment for post-traumatic stress disorder due to the alarms.
Let’s explore ways to improve medical device alarms so they don’t negatively impact the quality of care dispensed by medical staff or the health of patients.

Reducing Medical Device Alarms Frequency

Firstly, it’s crucial to decrease the frequency of medical device alarms to prevent alarm fatigue and don’t cry wolf for nothing.
The golden rule is to try to minimize the number of alerts, maintaining only those for urgent issues that require immediate staff attention.

According to Xiao and Seagull’s taxonomy, here are three types of unnecessary alarms that should be avoided:

False alarms

Several alarms are triggered depending on the sensor threshold. If thresholds are set too conservatively, there will be many false alarms.

Example

A blood pressure alarm with a threshold unsuited to the patient’s condition.

Solution

Allow for thresholds adjustments based on the patient and their state of health.

Nuisance alarms

The alarm is triggered regardless of the specific context.

Example

An apnea alarm is triggered when a patient is intubated.

Solution

This type of alarm is more difficult to avoid, but an intervention mode can be implemented to temporarily deactivate the alarm.

Inopportune alarms

The alarm is triggered at inappropriate times.

Example

An alarm indicates that the patient’s potassium level is too high, but with no short-term impact.

Solution

This type of alarm can be hidden during operations, but recorded and displayed afterwards.

Considering the Sound Environment of an Intensive Care Unit

To be sure you make the right choices when designing an alarm, you need to test your prototype in real-world contexts, although hospital constraints don’t always permit this.
When it’s feasible, this allows to consider the following parameters:

Noise and Alarms from Other Medical Devices

Each device in the ICU has its own alarm, which can sound simultaneously.
To enable medical staff to quickly identify the source of an alarm, each new device must have a unique sound signature with its own tone and level.
To determine the appropriate sound level, you need to prioritize the various medical devices in the room based on their significance. For example, the device that monitors the patient’s vital signs is more critical than others, and as such, should emit a louder beep to ensure it’s not overshadowed by alarms from other medical devices.

Communication Among Medical Staff

The volume of the alarms should not hinder the ability of the medical staff to communicate effectively in the room.

Background Music

Surgeons often operate with background music. The music level should also be considered.

Applying International Standard Recommendations

Since 2003, the IEC 60601-1-8 standard for electromedical equipment alarms has been addressing some alarm-related issues.

Compliance with this standard isn’t mandatory, but following these international guidelines can lead to an improved sound ecosystem in our hospitals.
The standard provides recommendations on the appropriate alarm type for each sound, as well as its frequency and tone. It’s worth noting that some leading hospitals only accept new medical devices that meet this standard.

Using Creativity to Innovate

As you can see, medical device alarms pose a significant challenge, and many experts are working on solutions.

After experiencing a traumatic hospital stay, electronic musician Yoko Sen decided to tackle the sound design of alarms, seeking innovative solutions. She founded a social company called Sen Sound , aiming to enhance the sound environment in hospitals.

In the Netherlands, students at the Delft Design Lab, led by Dr. Elif Özcan Vieira, developed a tool named Care Tunes, which converts a patient’s vital signs into melodies.

When might we see such technology implemented in our hospitals?

What About Artificial Intelligence for medical device alarms?

Artificial intelligence offers promising avenues for contextualizing medical device alarms. However, as with any new technology, we must remain vigilant, since a poorly trained algorithm could lead to fatal consequences.

Author & collaborators

Written by
François Longpré

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