The Intensive Care (ICU) and anesthesiology departments of the Catharina Hospital in Eindhoven are taking essential steps to make the ICU and operating rooms quieter and quieter. This initiative focuses on reducing alarm signals that unnecessarily burden healthcare professionals and patients.
Let this number sink in for a moment: one million alarms. That's an almost unimaginable number. Yet nurses, doctors, and patients in the ICU get to hear them in just three months. "That's a lot of stimuli," says intensivist Ashley de Bie with a sense of understatement.
"It can lead to alarm fatigue among care staff. Which can sometimes potentially lead to delays in critical situations," says Tineke de Vries , EngD researcher at TU/e and biomedical technologist in the clinical physics department.
Desensitized
She clarifies, "The consequence of multiple alarms is that nurses can become desensitized to these signals. This concept, alarm fatigue, can have harmful consequences if a critical situation goes unnoticed for a little longer. Alarms will never be completely ignored, but even a little delay in response can be dangerous."
De Bie emphasizes the importance of job satisfaction and the impact of alarms on patients. "Many alarms cause stress to caregivers, who moreover sometimes take them home (a quarter to a third of staff), and disturb the peace of mind of vulnerable ICU patients. Some patients even startle long after they are out of the ICU from everyday noises, such as at a railroad crossing, because they are reminded of the ICU experience."
Research has found that 85 (!) percent of ICU alarms are irrelevant to care. How can that be, you ask yourself. De Vries has an answer: "Sometimes up to three different alarms go off for one situation. These cause a lot of unnecessary stimuli. Often, alarms go off because a patient moves, but that is rarely something meaningful. And sometimes, a sensor gets disconnected. Good to know, but should this always be done with a loud signal tone?"
Different alarms
De Bie adds: "You have three types of alarms. Technical alarms that irritate healthcare professionals and are not even directly patient-related. Some alarms provide information that's nice to know but don't require immediate action. And then there are the critical alarms where you may need to act immediately."
So far, there is nothing new under the sun, although many people will not have known the above information either. De Bie: "The Catharina Hospital started a project to combat alarm fatigue last year, in collaboration with anesthesiology and TU/e professor Arthur Bouwman , among others. Thanks to the hospital's investments, we can now accurately record all alarms in the ICU and operating rooms. By measuring it, you can also study the alarms. This provides insight into the frequency and origin of the alarms."
With the data collected, Catharina Ziekenhuis can better understand which (unnecessary) alarms frequently occur. With this insight, settings or working methods can be adjusted, or consultations can be held with manufacturers to reduce the number of stimuli caused by alarms. A dedicated group has even been formed, to create alarm profiles and assess which profile can be used and when.
"With the data we have now, we can start looking very specifically at which alarms we can reduce quickly," De Bie said. "For example, when manufacturers of new devices now offer us a 'test drive,' we are much better able to assess whether they are giving more or fewer alarms and whether or not they are helping in our efforts to create quieter ICUs and operating rooms."
Ambition
The ambition is to reduce the number of non-relevant alarms by 50 percent. Ambitious? "Certainly, but also realistic," replies De Bie. "It will certainly take five to 10 years to expand and refine this project, also because other parties look at it from a different perspective. I am referring to manufacturers who naturally want to handle their responsibilities well and often choose to signal as much as possible due to legislation and guidelines requirements. This long period of research and implementation is worth it, though, because it is better for the patient and relieves healthcare professionals considerably."
De Vries concludes, "Legislation is changing, so manufacturers sometimes have to make other considerations. And with the knowledge we gain, we can make better demands on our suppliers." The duo emphasizes that reducing alarms is not at the expense of patient safety. Indeed, it should yield gains and less stress for patients.
The project to reduce alarm fatigue is being carried out in cooperation with the AI Expertise Center, the Healthcare Intelligence, HST (Housing, Services, and Technology), and clinical physics departments of Catharina Hospital. There is also a collaboration between Philips and TU/e within the e/MTIC (Eindhoven Medtech Innovation Center) partnership .
