Hospitals' New Issue: A 'Glut' of Machines Making Alarm Sounds (fiercehealthcare.com) 77
"Tens of thousands of alarms shriek, beep and buzz every day in every U.S. hospital," reports Fierce Healthcare -- even though most of them aren't urgent, disturb the patients, and won't get immediate attention anyways:
The glut of noise means that the medical staff is less likely to respond. Alarms have ranked as one of the top 10 health technological hazards every year since 2007, according to the research firm ECRI Institute. That could mean staffs were too swamped with alarms to notice a patient in distress or that the alarms were misconfigured. The Joint Commission, which accredits hospitals, warned the nation about the "frequent and persistent" problem of alarm safety in 2013. It now requires hospitals to create formal processes to tackle alarm system safety...
The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85% to 99% do not require clinical intervention. Staff, facing widespread "alarm fatigue" can miss critical alerts, leading to patient deaths. Patients may get anxious about fluctuations in heart rate or blood pressure that are perfectly normal, the commission said....
In the past 30 years, the number of medical devices that generate alarms has risen from about 10 to nearly 40, said Priyanka Shah, a senior project engineer at ECRI Institute. A breathing ventilator alone can emit 30 to 40 different noises, she said... Maria Cvach, an alarm expert and director of policy management and integration for Johns Hopkins Health System, found that on one step-down unit (a level below intensive care) in the hospital in 2006, an average of 350 alarms went off per patient per day -- from the cardiac monitor alone.... By customizing alarm settings and converting some audible alerts to visual displays at nurses' stations, Cvach's team at Johns Hopkins reduced the average number of alarms from each patient's cardiac monitor from 350 to about 40 per day, she said.
Hospitals are also installing sophisticated software to analyze and prioritize the constant stream of alerts before relaying the information to staff members.
The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85% to 99% do not require clinical intervention. Staff, facing widespread "alarm fatigue" can miss critical alerts, leading to patient deaths. Patients may get anxious about fluctuations in heart rate or blood pressure that are perfectly normal, the commission said....
In the past 30 years, the number of medical devices that generate alarms has risen from about 10 to nearly 40, said Priyanka Shah, a senior project engineer at ECRI Institute. A breathing ventilator alone can emit 30 to 40 different noises, she said... Maria Cvach, an alarm expert and director of policy management and integration for Johns Hopkins Health System, found that on one step-down unit (a level below intensive care) in the hospital in 2006, an average of 350 alarms went off per patient per day -- from the cardiac monitor alone.... By customizing alarm settings and converting some audible alerts to visual displays at nurses' stations, Cvach's team at Johns Hopkins reduced the average number of alarms from each patient's cardiac monitor from 350 to about 40 per day, she said.
Hospitals are also installing sophisticated software to analyze and prioritize the constant stream of alerts before relaying the information to staff members.
Honestly... (Score:5, Funny)
Honestly, if we can't solve the problem of nag screens on car radios telling us not to use them when moving EVERY SINGLE TIME WE START THE CAR then solving a beeper problem in a hospital might be a bit beyond us.
Re:Honestly... (Score:5, Funny)
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If you drive a Toyota, after three hours on the road the glass cockpit status display will be replaced by a coffee cup, which is supposed to prompt you to take a rest.
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Huh? I thought that meant take a pee break.
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Ya gotta have the machine that Goes bing
https://www.youtube.com/watch?... [youtube.com]
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Those are not warnings for the drivers, those are merely protection against lawsuits.
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And we couldn't managed to throw an error in the early days of smartphone cameras that tried to record in 9:16. Now all my real world disaster porn is forever cropped...
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Cars actually have the same problem these hospitals have, but at a smaller scale. There's so many damn things beeping and lights blinking and crap trying to get your attention that after a while you just start to tune it all out. That's one of things I like about my older car, which generally doesn't make noise or light up something on the dashboard unless there really is something that does need immediate attention.
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My 69 Ford obligingly lit up the HOT light maybe 5 seconds after I saw steam issuing from under the hood.
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And yet, people still left their blinker on back then too. Heck, blinker left on alarms are
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I'm a lot late to this discussion but I need to vent just the same:
If that damned startup nag screen telling me to drive safely would actually go away when I press the Continue button I wouldn't get so pissed at it.
The damned DING it makes anytime the temp goes below 37F where it says "IT MIGHT BE ICY BE CAREFUL" is also fucking irritating.
OK I'm done now...
Issues (Score:5, Insightful)
We do love causing problems for ourselves in creative ways. Which we then get to solve. But the solutions cause some more problems so....
That way almost nobody actually has to do any work.
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We do love causing problems for ourselves in creative ways. Which we then get to solve. But the solutions cause some more problems so...
Perhaps a slight change would be in order: "We do love causing problems for other people in creative ways".
And then there is Sevareid's Law: "The chief cause of problems is solutions".
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We do love causing problems for ourselves in creative ways. Which we then get to solve. But the solutions cause some more problems so....
That way almost nobody actually has to do any work.
Actually, it does cause work. If you can't find a solution, there's money to be made in prolonging the problem.
Sometimes... (Score:5, Funny)
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Hehe.. Task overload is a pain! Is is standard protocol that only a doc can remove the monitors (I honestly don't know, and it's an interesting bit of info)?
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Re:Sometimes... (Score:4, Interesting)
It is kind of odd that this problem has not been addressed properly; for datacenters this issue was identified, largely addressed, and eliminated as an issue. The automation is not that complicated, it just requires proper integration of devices.
Maybe this is why the medical industry is such a mess...
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No, it's not surprising. Different machines are made by different companies, and they all think their machine is exceptionally important. And they have failure modes that need to be addressed. (E.g., the IV drip has run out. This may be critical, or may just be "see to this soon", or even "get to this when you can" depending on what's in the drip. The drip machine doesn't know what's being dripped through it [well, it's got a code, but it doesn't really know what that code means], and it doesn't want t
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Seems the medical industry should have a similar department that centrally monitors and alerts the doctors and nurses directly based on urgency and importance.
Did your MSP have to get FDA approval for your management scripts? Update the approval each time you changed them?
That's the environment medical companies operate in, including the hospitals. Seemingly trivial adjustments need to be documented extensively, and perhaps recertified.
In some cases, the actually federal requirements aren't as strict as people think, but... all it takes is a bureaucrat with a burr under their saddle to make your life miserable trying to prove that regulation X really doesn't appl
Re: Sometimes... (Score:5, Insightful)
That problem has been solved. Hospitals like Kaiser are requiring all devices to report to a medical telemetry network, and as I understand it, it is similar to SNMP in being able to trend and prioritize data. I just assumed these initiatives were further along in the real world to translate into outcomes...
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It's just the other patients are getting really spooked by staring at that flat line
You missed a great chance to pull a funny gag.
Put a hospital bill in the deceased's hands . . . and tell the other patients that he flat-lined after reading the bill.
You wouldn't have been overworked anymore, as all the other patients would have skedaddled out of there.
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Beepers ignored in hospital (Score:2)
Sounds like a SOC (Score:2)
They'll need a ticketing system to help their 24/7 SOC full of analysts (nurses) to decide which events are medium or full escalation and depend immediate interaction with the client.
Soon they'll have a Machine Learning system in the cloud for event correlation, enrichment and automatic analysis.
They don't seem to be all connected (Score:2)
I spent a week and a half at the intensive care ward and in the end I learned to pause the alarms when I disconnected myself to visit the restroom(after having the catheter removed). :D The pump for the drip made a noise when it was done, the water level for the oxygen machine made a beep, but I could smell it before it was all empty, the machine monitoring heart, lung, pulse Vo2 etc had it's noise and I think it was only the last one that was connected to the room where they monitored everyone which were t
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In the intensive care unit, the nurse is in the hallway monitoring some computer screens and doing some other administrative work (reports). When the drip monitor goes off, the alarm is sounding in the room with the patient, which is not where the nurse is located. It's just mess. Dell just built a brand-new hospital in Austin in 2015 and could have worked with all the device vendors to integrate this stuff. They didn't
Interesting, but potentially solved elsewhere.. (Score:2)
I can't help but think this is very analogous to the metric checks and alerts in the monitoring systems in IT enterprises (Prometheus,ELK stack, PRTG etc.).
Pretty much all medical devices now are either network connected, or connectable, which bring up the potential to monitor them remotely on dashboards, using the same alerting criteria (which would have to be set by clinicians) as is used in those tools.
This way, you could have a lot less scary stuff blatting at the patient (but available on demand), and
Not a new issue (Score:2)
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Long as my machine design is indemnified, what do I care about patients? About a building drowned in noise? I don't even care if my alerts can even be heard, as long as I can legally claim it did one.
Because it's 2019 and every incident is a fingerpoint circus, "why wasn't there a safety feature" "the school should have done something" "the forklifts need human-detecting cameras". Everyone wants a payout, everyone wants to pass the buck, everyone is holding up their hands because steps 2 through 50 of any i
We had a similar problem at Texaco ... (Score:2)
... refinery in Port Arthur (Texas, not Australia).
I was an instrument man and the units would have a big red megaphone-like alarm horn for evac if a connected instrument had a cow.
The operators were not allowed to disable, so they stuffed the alarms with red rags.
It did bite them in the ass a few times and some people were killed.
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... refinery in Port Arthur (Texas, not Australia).
God your sentence confused the hell out of me given I have a friend from here: https://www.google.nl/maps/pla... [google.nl]
Your problem was not unique to Texaco, or even refining, or the oil industry .... or the process industry for that matter. The fundamental problem is alarms were regarded as a great means of alerting for an abnormal condition. But in the days of piped 0.2-1 bar to the control room alarms cost actual dollars to implement so people put a lot of thought into what to apply them to. Fast forward to th
Far More Than A Nuisance (Score:2)
This is the inevitable result of the medical instrument industry designing products in isolation and adding "alarms" just in case, perhaps from a perception of defensive design (from their perspective) - the audible equivalent of those boiler-plate warning booklets distributed with every consumer product these days.
But these alarms are dangerous is patients in at least two ways.
I'll start with the most direct way, which is the one most people are least aware of -- ICU syndrome. When someone stays in an envi
MY PRODUCT IS MOST IMPORTANT PRODUCT (Score:2)
"My product is most important product" attitude in product design is what leads to this. the products are not designed into the environment they are to be used with which have other products.
it's just the same thing as notifications on your smartphone. you've probably already started using your smartphone in muted mode 24/7 due to them, haven't you?
notifications from most single app would be okay, but having them from 20 sucks. and having them from 30 makes you ignore the notifications tray completely. does
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"My product is most important product" attitude in product design is what leads to this.
No it's not. What leads to this is the realisation that alarms are essentially free along with just a general marketing push for every product to be capable of generating an alarm (if the customer desires) and the fact that hospitals have only just gotten to the point where they are annoying.
Many other fields have been through this. Alarms become easy, customers just implement them everywhere, and eventually the industry
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The service that costs a gov/charity/private company less..
Falls off in a min after one test due to not sticking... Good enough for one test and it fails.
The other product that stays on the human for days due to good design and actually been tested.. but cost to gov... the owners... the charity
So buy the junk product in bulk and set the one test done quickly as a new standard
It affects the patients as well (Score:2)
I was hospitalized briefly after a bicycle crash. The cacophony of noise was unbearable. The worst was a loud shrill alarm that went off every 5-10 minutes and sounded until silenced. I asked about it and was told that it was an alarm from a CPAP that wasn't adjusted properly. Why don't you changed the settings, I asked. Because only a licensed something-something-something can change it and they aren't due on until sometime later. I couldn't imagine being the patient in that room. After a couple of hours o
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That's the thing; with all that noise it's impossible to rest, adding to the personal stress of the already exhausted patient.
The death of Gabriel (Score:1)
This reminds of the story of Leilani Schweitzer and her baby Gabriel. This story was covered in the Radiolab episode "Apologetical", which I recommend you listen to. The basics are that Leilani had to take her son to the hospital late at night, and they put Gabriel under observation, hooked up to several monitors. The monitors would sound off warnings frequently that did not let either of them sleep, so a nurse volunteered to silence the alarms. Unfortunately, she mistakenly turned off all warnings (inc
Fresh experience with exactly this! (Score:5, Insightful)
My wife had two six-day stretches of hospitalization during November. Most of this time was in a regular room, with about one-third of the time in the ICU. Both locations were crammed with electronic gear, some element of which found a reason to beep loudly every few minutes. There was even a loud alarm built into the bedside chair that sounded off whenever I had been sitting in it and got up, the rationale being that at times when the patient sits in that chair, staff needs to know if they might have fallen off it.
If a loud repetitive beep is supposed to summon help, why doesn't it bring an immediate response? And if the problem isn't immediate, why does the device need a loud warning? Why can't error conditions be quietly reported to the charge nurse desk, where screens are being continuously monitored?
My impression of the slow response to machine alarms was that because the same cacophany is coming from every other room in the pod, nurses have to prioritize their responses.
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It's getting to be like when some cheap-ass sensor in your house chirps every few minutes because of a failing battery, and it's impossible to tell where the chirp is coming from. I want a Constitutional amendment requiring all such sensors to be connectable to a smartphone app, which relays a useful message like BEDROOM SMOKE DETECTRr NEEDS BATTERY.
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Its worse than that. A big part of recovery is rest. My mom had a knee replacement surgery and didn't sleep at all the following days because of all the machines making noises, not just in her room but all the other ones. It sounded like a freaking fair ground with all the crazy going on. It's amazing to me this isn't being addressed. My mom slept several days solidly once at home, the experience was horrifying to her.
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report alarms to a station (Score:1)
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Alarm Fatigue (Score:2)
Yes, the alarm fatigue problem is very real
https://en.wikipedia.org/wiki/... [wikipedia.org]
It has been well known for years.
Yet another horror story... (Score:1)
I have always wondered if there (Score:2)
But then I have also wondered why the guy at the nuke plant control panel is on the public internet playing games @ MalwareGamesRUs.com.
What could possibly happen.
Just my 2 cents
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I work at a major teaching hospital, and medical devices do *not* have their own vlans, even though a number of us have been suggesting it for years.
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https://www.nccoe.nist.gov/sit... [nist.gov]
Shove this document into the inbox of the right decision makers ....... :-)
"Securing Wireless
Infusion Pumps
in Healthcare Delivery Organizations
Includes Executive Summary (A); Approach, Architecture, and Security Characteristics (B), and How-To Guides"
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Most infusion pump manufacturers have all released integration gateways to take pump messages upstream and push things like drug libraries downstream, and also push infusion events upstream for hospital systems and billing records etc.
AT the point of this integration gateways, it is not deeply difficult to push alarm messages to a central console ( i.e. at a nurses station) [this company I worked with had developed a Nurse console application to display ward level infusion pump data and alarms]
HL7 is probab
Earplugs and sleeping mask (Score:2)
Don't you ever forget those before entering a hospital.
You might not survive without because you'll never sleep otherwise.
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So what you have to solve the problem (Score:2)
But please don't remove the machine that goes "PING!"
Alarm Management (Score:2)
Sadly, hospitals know nothing about the application of alarm management.
https://en.wikipedia.org/wiki/... [wikipedia.org]
Incompatible systems (Score:2)
Then you have to get the fire alarm system beeps, security system beeps, various manufacturers of medical gear to all be able to interface their alarms together, from an administration staff trying to cut costs as much as possible.
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Cars honking for nothing, because they're at someone's house and want someone to come out
99% of the time it's a woman doing this.
Alarms compromise patient care (Score:2)
The last time I was in the hospital, the bedside monitor would sound red alert every time my O2 sat would briefly dip as I fell asleep, making sure that I did not sleep at all that night. The nurse said there was no way to silence the alarm. And then they wonder why hospital patients who stay more than a day or two start hallucinating and become delirious.
It's not just hospital equipment. Coming home with a Christmas tree the other day, we had the trunk lid tied down since the tree was a little too big to f
If only there were a machine to alert on sounds... (Score:2)
How to fix this (Score:1)
Buy better hardware. If it keep failing as hardware, try a much better product/service...
Make sure the products that connect to the human work, are usable and keep working...before buying into years of junk products that fail every day.
Dont allow staff who cant connect humans to hardware near the humans...
When the hardware fails do a "review"... was it a staff problem, the human removing hardware, failed junk hardware
True (Score:1)
alarm fatigue: unintended consequences (Score:1)
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Blame the lawyers (Score:1)
I have a feeling all of that is due to an ambulance chaser case. Well if there was a simple alarm on this our dearly departed Alice would still be here. Now Bob doesn't have a wife any more. We're asking for 2 million for this oversight.
Stupid juries award it.
The machine that goes 'bing' (Score:2)