July 27, 2018

The cacophony of hospital alarms can have unintended, and often dangerous consequences. Medical centers like Emory Uniersity Hospital in Atlanta are now addressing the problem.

By Katja Ridderbusch

It's a normal afternoon in the medical intensive care unit at Emory University hospital in Atlanta, one of six ICUs in the hospital. The hushed voices of staff members mix with the occasional beeping of alarm monitors. Ray Snider is the head nurse of the 17-bed unit. As he's walking along the hospital's winding hallways and passing the long row of patient rooms, he points to different machines.

"There's an IV pump, as well as the patient's ventilator," he explains. "Those are just some of the things we're getting alarms from."

Other devices track a patient's heart rate, pulse, blood pressure, temperature or blood oxygen level.

It’s pretty quiet here now as far as the beeping goes. But a few years ago, Emory's medical ICU had up to 1400 alarms per bed per day, a cacophony of beeping, buzzing, ringing and pinging. More than most nurses can handle. Across the entire hospital, it added up to tens of thousands of alarm sounds on one single day.

About 90 percent of them were false alarms, or alarms that didn't require an immediate medical response.

Eventually, the staff became de-sensitized. The alarms turned into background noise. And the urgent beeps intended to let staff know something was wrong instead came to mean there was probably nothing to worry about.

Pam Cosper is the director of critical care nursing at Emory University Hospital.

"We had an incident a while ago, when the alarm went off," she remembers. The nurse had just been to the patient's room and thought that it was a false alarm. "But when she actually responded to the room the patient was on the floor," Cosper says. "Those are things we never ever want to have happen to a patient we care for."

It's a phenomenon known as alarm fatigue, and it has had dire consequences. According to national data, several hundred patients died in recent years as a direct or indirect result of an alarm-overkill.

And that's probably just the tip of the iceberg. "We see this as a safety issue," says Dr. John Rogers. "It's not an issue of our annoyance." Rogers is an ER doctor in Macon and president-elect of the American College of Emergency Physicians.

"We want to make sure we don't miss an alarm that really needs to be responded to," he continues. "But we don't want to have so many false alarms that we become numb and disregard them."

Five years ago, the Joint Commission, which is a quality control group for hospitals, put alarm fatigue on the top of the list of problems for hospitals to tackle.

Emory was among the first to take on the issue and implement changes. By now, Emory's medical ICU has driven down the number of alarms from 1400 to about 300 per bed per day. That's still a lot, and the hospital is determined to lower it even further.

One way to do this is to customize the monitor settings for individual patients.

Take, for example, a 25-year old competitive runner with a resting heart rate in the 40s. The machine's default setting is typically between 50 and 150, so it would constantly alert for low pulse. For the 70-year old overweight patient with high blood pressure, it may be a different story.

But in the emergency department, customizing can be difficult. "We don't have a lot of time to get to know people," says John Rogers. "We don't have a lot of background information, so we don't know what their normal performance is."

Another way to fight alarm fatigue is changing some of the alerts from audible to visual. "It was actually bedside nurses, who suggested these large displays as a way to make better awareness in any ICU environment," says nurse Pam Cosper, while she's pointing to about a dozen screens around her. They make the nurses' station look like a control room.

She adds that she sees this "as another way to be able to gain the nurses' attention." Nurses are constantly interacting with patients and staff members and walking around in the ICU and the ER. "Having these big screens is a real game changer," says Cosper.

There are also some basic things that help reduce false alarms. Like, frequently changing disposable electrodes, checking for lose cables, and cleaning the patient's skin before placing the pads.

Head nurse Ray Snider says they are also working on ways to use artificial intelligence to filter the patients' data before the alarms start beeping.

In a future scenario, "computers would critically analyze the data that's coming from all the machines and only alert the staff when something is truly going on with a patient," explains Snider. "That’s where we’ve got to go."

Nurse Pam Cosper likes all the new technology that has made the hospital a quieter place. But she says it doesn’t replace the old-fashioned bedside check.

"What we don't want is nurses to be so focused on technology that we lose sight," she warns. Looking at the patient in person and making an assessment is still very critical, she adds. "You can't just trust the machines."

© WHYY - The Pulse / Katja Ridderbusch