Guest Column | October 23, 2017

False Alarms Have Real Consequences In Hospitals

EHRs: Not Just For Hospital Use Anymore?

Three tips for reducing alarm fatigue and improving patient safety.

By Todd Plesko, Vice President of Product Strategy, Vocera Communications, Inc.

As we go through our days, we are surrounded by a variety of alerts: clocks alarm in the morning, microwaves ding at lunch and dinner, smartphone reminders chirp throughout the day, and sounds of text messages are often in between. At times, we can feel overwhelmed by all this constant electronic communication. For front-line nurses and other care team members at hospitals, a barrage of alarms and alerts also can feel exhausting or disruptive at times if not properly coordinated, managed and triaged. And, in the hospital setting, alarms and alerts truly can be a matter of life and death.

The toll of alarm fatigue on clinicians was detailed in depth in a recent study published in JAMA Pediatrics. The study, which likely has applicability beyond pediatrics relevant to any med/surg unit, reveals that the burnout caused by an overdose of alarms delays response times and clouds decision-making processes for nurses.

For instance, when nurses are overwhelmed with the sheer number of alarms, they may selectively respond only to alarms indicating a fatal condition. The study showed that alarms for lethal conditions saw a response of just one minute. However, the average for all other clinician responses to alarms was around 10 minutes. Or they may instinctively respond first to those patients who have previously required intervention (average response time of 5.5 minutes) compared with patients who did not (10.7-minute response time).

Alarm fatigue worsens with time on the job, or with greater responsibility. For instance, veteran nurses took 8.8 minutes to respond to patient alarms, twice the time it takes a nurse with less than one year of experience. Meanwhile, nurses responsible for two or more patients took an average of 10.6 minutes to respond to an alert, while those who care for one responded in 3.5 minutes.

Filter Out The FYIs
Nurses and other clinicians are so inundated with non-actionable, “FYI” alerts that when something urgent occurs, they are already at what’s called “peak cognitive load.” Peak cognitive load might best be compared to a computer hard drive that is full. Since we can’t go out and buy more human memory or processing speed, we need to get rid of some of the irrelevant files in the human hard drive to free up space for what is most important.

Solutions to alarm fatigue should focus on filtering out the FYIs, or non-actionable notifications, from a variety of different systems all vying for clinicians’ limited cognitive load. These systems, including traditional pagers, overhead paging, electronic health records, physiologic monitors, nurse call and more are often disconnected because they are from different vendors

An enterprise strategy to resolve alarm fatigue must be comprehensive, integrated, and multichannel. It should have the capability to capture, filter and prioritize alarms, alerts, text messages and voice communications. It also should highlight actionable items that need immediate response across all channels. This will help reduce clinicians’ cognitive load, enabling them to respond more quickly, with clear decision-making processes.

It’s important for healthcare leaders to avoid unintentionally adding to caregivers’ cognitive load by implementing piecemeal solutions that require nurses to disrupt their workflow to check an app or open and close different programs on a computer. The best enterprise solutions should organize alarms in one view.

Customize To Optimize Care
While a single, integrated solution can best address the breadth and depth of healthcare organizations’ alarm fatigue challenges, it’s also important to customize the approach to the needs of different units, clinician roles, or even individual caregivers. Here are some ways to tailor alarm fatigue solutions to the unique needs of a hospital:

  • Reduce the number of caregivers who receive a given alert to only those who directly care for that patient. Deploy a rules engine to determine who are the right caregivers to receive a given message, and send notifications directly to their mobile devices
  • Give clinicians and staff the flexibility to choose the right device for the role, including a smartphone, hands-free communication badge, VoIP handsets, or workstation. Allow clinicians to create unique ringtones for specific events
  • Facilitate quicker care team collaboration and responses to patient events. Route notifications to multiple groups and individuals based on caregiver location, role, title, department, and/or group, and patient room or bed assignment
  • Enable caregivers to identify the most urgent patient needs faster by prioritizing events that occur at the same time
  • Support clinical decision making: Assemble relevant information from multiple systems such as the electronic health record (EHR), lab values, and ADT data to accompany event notifications

Introduce The Concept Of “Event Response”
In days past, alarm and event management solutions were designed primarily around pagers, meaning it was a unidirectional communication. Someone would be notified of an event and the workflow ended there. Smartphones and the next generation of alarm and event management middleware platforms are upping the ante by treating workflows more holistically. Specifically, the workflow doesn’t end with a caregiver being notified of an event; in fact, that is only the half-way point now.

The concept of event response is to ask the question, “Now that I have the information, what do I do with it? How can I communicate and collaborate with care team members to affect the best response to this event?” A few intelligent systems can now incorporate the context of the event and the ability to respond all in one, contextual and highly informative view. This is a big satisfier for caregivers as they not only have been notified of the event, but they also have both the context around the event and the ability to easily respond to it by intuitively communicating, by either voice or text, inside of the context of the event.

While the concept of event response is not new, the technologies enabling it to be used effectively in healthcare is new and very exciting.

Invest For Patient Safety
One of the most striking findings in the JAMA study was that veteran nurses, with their invaluable clinical expertise and judgment, are the most compromised by the cumulative effect of alarm fatigue over the years. This finding is a cost to patient safety that healthcare systems simply cannot afford. Hospitals must find a comprehensive approach to managing alerts and alarms that safeguards nurses’ cognitive loads and only requires their attention for actionable notifications at the right time.

By combining and prioritizing disparate notifications across channels and vendors, solutions can also deliver new intelligence about which patients need immediate assistance, providing a 360-degree view of the patient’s health status. But these new insights can only be leveraged if we first lower clinicians’ cognitive load—erasing unnecessary files from their human hard drive—so they can rapidly respond to the signals that are truly clinical emergencies.

About The Author
Todd Plesko is the Vice President of Product Strategy at Vocera Communications, Inc. Prior to his role at Vocera, he was the co-founder, CEO and Board Chairman for Extension Healthcare, which was acquired by Vocera in October 2016. Mr. Plesko is highly active in the healthcare information technology community and is a subject matter expert in clinical communication and workflows. Prior to co-founding Extension Healthcare, he served as CIO for a large provider network and led two other successful startups focused on ambulatory care practice management systems, ambulatory care EHRs, hosting, and clinical workflow solutions and infrastructure.