Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue

Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review

Objective

This study aimed to systematically evaluate the level of medical equipment alarm fatigue and its influencing factors among clinical nurses.

Methods

PubMed, Embase, CNKI, and Wanfang databases were systematically searched to identify articles on alarm fatigue of clinical nurses published before September 25, 2022. According to the evaluation criteria of prevalence studies recommended by JBI Evidence-Based Health Care Center, the quality of the literature meeting the inclusion criteria was evaluated, and Stata MP17 software was used for meta-analysis.

Results

A total of 14 cross-sectional studies were included, with a total sample of 2,848 nurses. The results showed that the alarm fatigue score of clinical nurses was 21.76 (95% CI [20.27, 23.25]). Subgroup analysis showed that the nurses who worked night shift and had lower professional title had higher alarm fatigue.

Conclusion

The alarm fatigue of clinical nurses was at a moderate level. To reduce the alarm fatigue level of clinical nurses, nursing managers should strengthen the alarm safety awareness of nurses, rationally arrange nurse manpower, carry out training to actively improve the alarm management ability of nurses, and optimize the alarm level and frequency of alarm equipment.

Computational approaches to alleviate alarm fatigue in intensive care medicine: A systematic literature review

Patient monitoring technology has been used to guide therapy and alert staff when a vital sign leaves a predefined range in the intensive care unit (ICU) for decades. However, large amounts of technically false or clinically irrelevant alarms provoke alarm fatigue in staff leading to desensitisation towards critical alarms. With this systematic review, we are following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist in order to summarise scientific efforts that aimed to develop IT systems to reduce alarm fatigue in ICUs. 69 peer-reviewed publications were included. The majority of publications targeted the avoidance of technically false alarms, while the remainder focused on prediction of patient deterioration or alarm presentation. The investigated alarm types were mostly associated with heart rate or arrhythmia, followed by arterial blood pressure, oxygen saturation, and respiratory rate. Most publications focused on the development of software solutions, some on wearables, smartphones, or headmounted displays for delivering alarms to staff. The most commonly used statistical models were tree-based. In conclusion, we found strong evidence that alarm fatigue can be alleviated by IT-based solutions. However, future efforts should focus more on the avoidance of clinically non-actionable alarms which could be accelerated by improving the data availability.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233461, identifier: CRD42021233461.

A Fundamental Cognitive Taxonomy for Cognition Aids

OBJECTIVE

This study aimed to organize the literature on cognitive aids to allow comparison of findings across studies and link the applied work of aid development to psychological constructs and theories of cognition.

BACKGROUND

Numerous taxonomies have been developed, all of which label cognitive aids via their surface characteristics. This complicates integration of the literature, as a type of aid, such as a checklist, can provide many different forms of support (cf. prospective memory for steps and decision support for alternative diagnoses).

METHOD

In this synthesis of the literature, we address the disparate findings and organize them at their most basic level: Which cognitive processes does the aid need to support? Which processes do they support? Such processes include attention, perception, decision making, memory, and declarative knowledge.

RESULTS

Cognitive aids can be classified into the processes they support. Some studies focused on how an aid supports the cognitive processes demanded by the task (aid function). Other studies focused on supporting the processes needed to utilize the aid (aid usability).

CONCLUSION

Classifying cognitive aids according to the processes they support allows comparison across studies in the literature and a formalized way of planning the design of new cognitive aids. Once the literature is organized, theory-based guidelines and applied examples can be used by cognitive aid researchers and designers.

APPLICATION

Aids can be designed according to the cognitive processes they need to support. Designers can be clear about their focus, either examining how to support specific cognitive processes or improving the usability of the aid.

A call to alarms: Current state and future directions in the battle against alarm fatigue

Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes clinicians to experience sensory overload when attempting to sort real from false alarms, causing desensitization and alarm fatigue, which in turn leads to adverse events when true instability is neither recognized nor attended to despite the alarm. The scope of the problem of alarm fatigue is broad, and its contributing mechanisms are numerous. Current and future approaches to defining and reacting to actionable and non-actionable alarms are being developed and investigated, but challenges in impacting alarm modalities, sensitivity and specificity, and clinical activity in order to reduce alarm fatigue and adverse events remain. A multi-faceted approach involving clinicians, computer scientists, industry, and regulatory agencies is needed to battle alarm fatigue.

Human Factors and Simulation in Emergency Medicine

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals to effect change. Implementing HF in EM through health care simulation will require a demonstration of clinical and safety outcomes, advocacy to stakeholders and administrators, and establishment of structured collaborations between HF professionals and EM, such as in this breakout group.

Trends and Progress in Human Factors and Organizational Issues in 2016: Learning from Experience

Objective: To summarize significant research contributions on human factors and organizational issues in medical informatics published in 2016. Methods: An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions published in 2016 that address human factors and organizational issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. Results: The five selected best papers present studies with rigorous methods, properly designed and described and are, therefore, efficiently reusable for other researches. Conclusion: Human factors and ergonomics- based interventions must be tailored to the context, but meaningful ways must be simultaneously found to generate a stronger evidence base for research and to provide efficient, easy to implement, and useful methods.