Mimi Zander

Alarm fatigue is a phenomenon where nurses and other clinicians will ignore or respond more slowly to an alarm if it is preceded by many false alarms (think The Boy Who Cried Wolf). The problem is so widespread that Emergency Care Research Institute (ECRI) lists “Alarm Hazards” (for the fourth year in a row) as their number one health technology hazard. It’s clear from observing a hospitalized patient hooked up to a monitor that our monitoring devices are problematic, to say the least. When an alarm fires, it should indicate a change in the patient’s status that requires an intervention or a change in management.

What I find deeply satisfying about this work is that the scope is relatively small but the impact is potentially huge.

What did your research involve?

I worked on three distinct projects at CHOP this summer. First, the pilot that I helped design focuses on eliminating alarm fatigue in hospitals by using video cameras in hospitalized patient’s rooms to record patient care. We’ve made a lot of progress – data collection is nearly finished and we have made a serious dent in reviewing video and alarm annotation. The next project is a systematic review on alarm fatigue. After more than 1.5 years of meticulous work by the team, we have submit our manuscript for publication. The third project is in a very early stage. We are trying to evaluate who is generating the most alarms in our hospital and why. We’ve had some difficulty getting this off the ground, but are almost on our way to collecting and analyzing data. I look forward to continuing to work on this during the school year.

What is it like to watch patient care from this perspective? 

After recording patient care with 6 GoPro cameras, we would import the footage, edit it so all camera angles are visible at once (kind of like security camera footage), download a spreadsheet of all of the alarms that fired during the study period, and then with a little patience and some subtraction, we lined up every alarm that fired with the video.

I spent hours reviewing hundreds of hours of patient care videos in order to determine whether alarms were valid (reflect the patient’s physiologic status) and actionable (a clinician intervenes or changes the patient’s care in some way). This task forced me to observe and listen to the patient’s room for six-hour stretches. There was chirping and buzzing from monitors and pumps, quick and slow footsteps of nurses, patients, and visitors, wheels scraping the floor, staff calling out to each other — the familiar sounds of any hospital.

I can safely say that the past couple thousand alarms I’ve looked at have alerted no one to anything significant. But there they are, sitting neatly in our database and firing at the bedside. Of course, it’s tedious to evaluate every SPO2, PVC, heart rate, or respiratory rate alarm that fires. But it’s much more tedious to be a nurse on the floor being bombarded with hundreds of alerts to a problem that is not “real” while taking care of other patients.

What keeps you motivated?

I’m empowered by every inconsequential alarm that I annotate in our database—every false alarm that we recognize is one step closer to safer monitoring systems that do not bury clinically important alerts in noise. We will be successful if our work influences standards of care or alerts device manufacturers to change their alarm algorithms. For now though, we need to start by raising awareness of the noisy patient care environments that we are creating and begin to rethink how we can purposefully interact with the technologies that surround us.

Patience and diligence are key. Sometimes you lose an entire day of data because of a technological problem or human error. The real challenge is how you handle the recovery. In research, you dust yourself off, report your error, figure out what went wrong, and take steps to ensure that it never happens again. And you do this over and over until you get it right.

Mimi’s answers have been adapted from The Society of Hospital Medicine’s blog, The Hospital Leader. She has published four posts documenting her summer at the Children’s Hospital of Philadelphia. She and her research team were recently interviewed by WHYY, Philadelphia’s NPR affiliate.