263 © Springer International Publishing Switzerland 2017 J.A. Sanchez et al. (eds.), Surgical Patient Care, DOI 10.1007/978-3-319-44010-1_17 Redesigning Hospital Alarms for Reliable and Safe Care Paul Barach and Juan A. Sanchez P. Barach, BSc, MD, MPH (*) Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, 5057 Woodward Avenue, Suite 13001, Detroit, MI 48202, USA e-mail: Pbarach@gmail.com J.A. Sanchez, MD, MPA Department of Surgery, Ascension Saint Agnes Hospital, Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA e-mail: Juan.Sanchez@stagnes.org 17 “Even the boy who cried wolf was right about the wolf once.” —Sherry Thomas Introduction Noise levels in hospitals have been rising for decades and are far higher than guideline values established by the World Health Organization. Alarms contribute significantly to noise pollution in healthcare facilities. Alarm safety is one of healthcare’s most high-profile and intractable problems. A phenomenon known as “alarm fatigue,” including limited capacity to identify and prioritize alarm signals, has led to delayed or failed alarm responses and deliberate alarm deac- tivations. Alarm fatigue has been implicated, according to federal agency reports as well as in the lay press, in patient morbidity and deaths, some highly publicized. Between 200 and 566 patient deaths have been reported to have died from 2005 to 2014 as a result of alarm misman- agement; these numbers are likely to be underes- timates. 1 Many factors contribute to alarm fatigue, but perhaps most significant is a reported false alarm rate of as high as 90 % among mil- lions of alarm signals. These large numbers of clinically irrelevant signals directly contribute to staff desensitization. In addition, high back- ground noise levels in critical care and variable acuity units and in operating rooms contribute to alarm response failures. They do this by further increasing the cognitive load on staff; escalating distraction and irritability; and complicating dis- cernment, attribution, and communication. If, however, alarms are intended to maintain a level of situational awareness, designers need to engineer monitoring devices able to do some or all of the following: distinguish artifact from real patient status changes, determine whether these changes are contextually important, convey the source of the alarm to the receiver, and allow prioritization when operational attention is directed elsewhere (e.g., dur- ing line placement) or when multiple alarms sound. Multiple levels of influence and opportunities for system intervention and innovation exist to facilitate timely and reliable alarm responses. These include addressing the broader acoustic con- text, clinician responsibility, deployment and 1 ECRI Institute. ECRI Institute releases top 10 health technology hazards report for 2014. November 4, 2013. https://www.ecri.org/Press/Pages/2014_Top_Ten_ Hazards.aspx Accessed January 3, 2014.