China
Africa
Explore chapters and articles related to this topic
Introduction to Clinical Surveillance
Published in John R. Zaleski, Clinical Surveillance, 2020
Thus, the purpose of clinical surveillance is twofold: (1) provide the earliest of notifications regarding patient decompensation or decline, while (2) reducing the number or quantity of false alarms communicated to the care provider that minimize or negate false negative events. The challenge is how to communicate only the essential, clinically actionable information while suppressing the non-clinically actionable information. Accomplishing this balance is an art, as the measurements used to identify significant clinical events do not always carry complete or correct information. This fact has led to what has been published in recent years as the concept of “alarm fatigue” [28]: excessive communications of alarm notifications associated with medical devices based on measurement threshold breaches. Most alarm signals generated using signal threshold breaches have been shown to be almost entirely non-clinically actionable (as will be discussed later). Hence, the potential to notify clinicians incorrectly that there is an actionable event occurring with a patient can and does result in inefficiency, time and effort waste, and physical and mental fatigue on the part of the clinician—fatigue that can indeed result in the possibility of patient harm due to the fact that the provider is distracted or ignores the continuing or repeated annunciations of non-actionable alarms and notifications. Approaches to ameliorating alarm signals have been reported for years, and many techniques have been suggested, ranging from imposing delays on the annunciation of an alarm to changing the threshold values to be less sensitive.
Auditory Display in Workplace Environments
Published in Michael Filimowicz, Foundations in Sound Design for Embedded Media, 2019
Salient features of auditory displays and sonifications (i.e. “the use of nonverbal audio to convey information”; Kramer et al. 1997) are summarized by Kramer (1994a). The systematic and reproducible transfer from data domains to sonification domains is denoted as “data mapping.” Before dealing with aspects of sound design and generation, sonification designers face the essential challenge to define appropriate mappings. Also, considering auditory perception, including (ecological) psychoacoustics (Neuhoff 2004; Walker and Kramer 2004) and Gestalt psychology (Bregman 1994), is critical to the development of auditory displays that present meaningful information without causing listeners’ annoyance. Literature refers to terms such as “alarm fatigue” (Paterson et al. 2016), frequently caused by a high rate of “false positive” alarms (Hildebrandt et al. 2016), namely sounding alerts without evidence.4 “Alarm flooding” (Viraldo and Caldwell 2013) denotes, for instance, the risk of causing users to interrupt their primary tasks to silence alarms instead of solving the causing problem (Xiao et al. 2000), while “alarm showers” (Johannsen 2004) consist of a sequence of interdependent errors causing multiple alerts that overburden operators on duty (Hearst 1997). Frequently, auditory alarms are considered to be “redundant to the operators’ work” with the consequence of being ignored or even switched off (Li et al. 2012). Brock et al. (2005) mention even the clipping of wires in order to make buzzers keep silent. Inattentional deafness (Chamberland et al. 2017)—the failure of noticing sounds—is another risk of auditory overloads caused by inappropriately designed and implemented sonifications neglecting aspects of auditory perception and working environments.
Cognitive Aids in Emergency Medical Services
Published in Joseph R. Keebler, Elizabeth H. Lazzara, Paul Misasi, Human Factors and Ergonomics of Prehospital Emergency Care, 2017
Keaton A. Fletcher, Wendy L. Bedwell
Alarms are defined as auditory warnings that increase situational awareness and vigilance and can advise required actions (Catchpole et al., 2004). Alarms should signal severity (e.g., louder alarms for more serious problems) and location (e.g., tonal sweeps that allow for auditory localization) and be unique to each event type (Celi et al., 2001; Catchpole et al., 2004). They have the capability to alert individuals to the most important or pressing issues in an environment and are considered “hard defenses” against error (Reason, 2000). An alarm for cardiac arrest, for example, eliminates the need to repeatedly check heart rate and compare it to safe levels. Although alarms, like checklists, are designed to ultimately influence behavior, their primary purpose is structuring cognition. In other words, alarms do not provide much information about how to solve a problem (i.e., behaviors) but primarily inform individuals that there is an issue, and what that issue is (i.e., cognition). As previously mentioned, the pitch or pattern of alarm can trigger a cascade of thoughts that ultimately leads to actions designed to eliminate the cause of the alarm. This motivated behavior can occur faster and more accurately because individuals have been trained on the meaning of the alarms and have created an accurate and effective cognitive structure. The users then have little need to search their environments for the source, instead relying on their knowledge of the alarm to inform their thoughts and, ultimately, actions. However, like checklists, alarms have been subject to overuse and improper application, which leads to a desensitization to all alarms, a phenomenon named alarm fatigue (Cvach, 2012). Despite published standardization of medical device alarms (IEC, 2006), they are often difficult to discriminate and do a poor job of signaling the severity of the issue (Sanderson et al., 2006). Coupled with a lack of training on the nuances of the various alarms, this has increased rates of alarm fatigue and physiological strain (Morrison et al., 2003).
Adopting the audible alert system for the electronic chart display and information system for improvement of early navigational situation awareness
Published in Journal of International Maritime Safety, Environmental Affairs, and Shipping, 2020
Inchul Kim, Soyeong Lee, Ikhyun Youn
What is even more important and problematic is not the case of reacting to the alarm, as in the above case, but the case of not responding to the alarm. Researches on alarm fatigue have been extensively conducted in the medical field. Alarm fatigue, which jeopardizes safety, is due to sensory overload caused by an excessive number of alarms, and it is known to lead to insensitivity to alarms and result in alarm-related death (Sendelbach and Funk 2013; Ruskin and Hueske-Kraus 2015).
Data-driven monitoring in patients on left ventricular assist device support
Published in Expert Review of Medical Devices, 2022
Lieke Numan, Mehran Moazeni, Marish I.F.J. Oerlemans, Emmeke Aarts, Niels P. Van Der Kaaij, Folkert W. Asselbergs, Linda W. Van Laake
An extensive effort is still required before algorithms can be used prospectively (Figure 3). Improvement in appropriate and early notification of abnormalities without having too many alarms is needed, as alarm fatigue will hamper the successful implementation of a new monitoring strategy. Algorithms are ideally personalized and dynamic, where decisions in the trade-off between sensitivity and false alarm rate are critical. Improvements in early pump malfunction detection are a prerequisite for the success of telemonitoring in LVAD patients. Those algorithms can be improved using high-density data. Data storage on the most currently used LVADs is limited, complicating the development of prediction algorithms. A miniaturized data recorder was developed to solve this, enabling high-density pump data retrieval from HVAD. Such high density data allows us to study the mechanisms of suction and the relationship between suction and tachyarrhythmia. Even more sophisticated algorithms could make use of continuous data, with waveform analysis. Those waveforms offer much more valuable information than just average values of power, flow, and PI, to estimate the left ventricle function [31]. For example, Grinsteil et al. showed that the ventricular filling phase slope of the HVAD flow waveform correlates with the pulmonary capillary wedge pressure [38]. This would also help in the development of LVAD speed control systems in the future, to reduce suction rates. Another challenge, is to monitor pump parameters online. Despite major progress in the development of algorithms, the majority is tested retrospectively and not used prospectively. Ideally, a system is developed that automatically sends pump parameters for example to a smartphone, that in turn sends it to a secured server that enables healthcare providers to assess the patient’s status. Security and privacy may be at risk and should therefore be addressed appropriately, i.e. by encrypting patient data. A possible solution for security and privacy of telemonitoring data suggested by Taralunga et al. is a block chain enabled framework [62]. Another important aspect that needs to be arranged is assigning additional staff in telemonitoring centers to assess alarms and monitor LVAD patients remotely [61]. Since the implementation of telemonitoring directly results in additional costs, cost-effectiveness studies are warranted. With increasing numbers of patients on LVAD support, a regional or national monitoring center with trained personnel could filters the false alarms.