Alarm Fatigue Remains a Top Concern in Health Care IT: Report

Improving management of alerts is an issue to watch for health care professionals, according to an ECRI Institute report.

Health systems need to implement new strategies to address alarm fatigue, nonprofit scientific research firm ECRI Institute revealed.

Critical care units receive as many as 350 physiological monitor alarms per day, ECRI reported in its "Top 10 C-Suite Watch List" of technology issues facing health care IT leaders in 2013 and the future, announced on Feb. 19.

From one to 10, the Watch List included electronic health records (EHRs), mobile health, alarm integration technology, minimally invasive cardiac surgery, imaging and surgery, positron emission tomography (PET)/magnetic resonance (MR) imaging, bariatric surgery, supply chain, radiation dose safety and lung cancer screenings.

For 2012, alarm fatigue was the No. 1 hazard faced by hospitals, and for the 2013 report it was No. 3 on the watch list, according to ECRI.

With the plethora of alarms, clinicians may not know which ones are urgent. They receive notifications for equipment such as ventilators, infusion pumps and medical telemetry (or remote monitoring) devices. If caregivers miss a notification due to alarm fatigue or sensory overload, they may not be able to respond to critical situations, which could result in patient deaths.

Alarm integration systems are in the early stages of development, according to the report. When integrating alarms, hospitals need to ensure that essential alarms don't get dropped when they're transferred from a communication system to an integration system, ECRI reported.

Caregivers also must consider the value of each alarm they create, Robert Maliff, director of ECRI's applied solutions group, told eWEEK in an email. A hospital's existing network may not be able to handle alarm notification, he noted.

ECRI encourages collaboration among IT staff, doctors, nurses and engineers to ensure that alarm issues are addressed. "Nursing, IT and clinical engineering all have valuable input as to how the best alarm integration environment should be designed," said Maliff. "And to monitor success, the hospital should examine the efficiency of alarm response. That is, are alarms responded to—and resolved—in a quicker fashion."

An alarm escalation policy must be incorporated into an integration system's notification processes, said Maliff.

Doctors often carried multiple pagers, but now the alerts can be sent to physicians' mobile devices. An iPhone app from Voalté, called Voalté One for iPhone, combines voice, alarms and text on the Apple handset so clinicians don't have to carry multiple pagers.

Meanwhile, Philips Healthcare's IntelliVue Information Center IX platform includes an Alarm Audit Log that allows hospitals to analyze alarm data and reduce non-actionable alarms.

In addition, medical body area networks (MBANs) could limit alarm fatigue in the future, Anthony Jones, chief marketing officer for patient care and clinical informatics at Philips Healthcare, told eWEEK in May 2012. At that time, Philips along with GE Healthcare and the Federal Communications Commission proposed that wireless spectrum be allocated for MBANs, which are short-range networks composed of small, low-power sensors that pick up vital data when placed on the body. Sensors may measure body temperature and respiratory function.

EHRs were the No. 1 concern among technical experts in the ECRI watch list due to incorrect data being entered into patient records, said Maliff.

Another problem with EHRs was inadequate data transfer from one health IT system to another. Interoperability of EHR data is an ongoing problem that the industry is working to address.