August 12, 2019 / 8:38 PM / 4 months ago

Alarms in emergency rooms rarely important, which can desensitize staff

Walk into any emergency room in the U.S. and you’ll hear a regular din of beeping alarms going off from machines connected to patients. But a new study found only a tiny fraction of the alarms signals a condition important enough to require a change in the patient’s care.

And that creates a problem: the nearly constant din tends to desensitize hospital staff to the sounds, a phenomenon dubbed “alarm fatigue,” which can result in real emergencies being missed, researchers warn in The American Journal of Emergency Medicine.

Patients who are not critically ill need to be monitored, but “that doesn’t mean every little thing needs to be alarmed,” said the study’s lead author, Dr. William Fleischman, director of quality and implementation science at Hackensack Meridian Health in New Jersey. “For example, if there’s an extra heart beat the alarm will put out a beep, but that may be a finding that is clinically meaningless.”

In the U.S., “we think the more monitoring there is, the better off the patient will be,” Fleischman said. “But the more alarms go off, the more the staff gets desensitized to the sound.”

Usually that doesn’t result in ill effects for the patient, but Fleischman recently had the experience of walking by a patient whose alarm was sounding with no one responding. That patient turned out to have an oxygen saturation - the amount of oxygen in the blood - of 50%, a life-threatening situation. He alerted staff and the patient “was put on a breathing machine.”

“That kind of thing happens across the country every day,” Fleischman said.

To get a better idea of how often alarms signal real patient distress, Fleischman and his colleagues set up an experiment. One of the physician researchers spent several days in the emergency room observing patient characteristics, types of alarms that were beeping, staff responses to the beeping, whether the alarm was in response to something real and whether the alarm resulted in any change in the way the patient was managed.

During a total of 53 hours, 1049 alarms went off, associated with 146 patients. Alarms changed the clinical management of a patient just eight times, or 0.8% of the time. ER staff did not respond to 63% of the alarms.

One solution might be to make the alarms less sensitive, Fleischman said. Often, monitors are left with the factory default settings, he explained.

That makes sense to Maria Cvach, director of policy management and integration at the Johns Hopkins Health System. At Hopkins, “nurses are allowed to customize monitors based on baseline measurements - otherwise they would be ringing all the time,” Cvach said. “For example, heart rate monitors are usually set at to beep if the rate goes under 50 or over 120. If the patient comes in and (has a heart rhythm issue) with a rate of 130, you might customize the monitor for that patient.”

Unfortunately, Cvach said, “a lot of hospitals won’t let you do that. We let the nurses at bedside who know what the baseline is, set up a customized range that can go 10 percent above and below the baseline.”

The study underscores the downside of overly sensitive alarms, said Dr. Erick Eiting, an associate professor of emergency medicine at the Icahn School of Medicine at Mount Sinai in New York City and vice chair of operations for emergency medicine at Mount Sinai Downtown.

“I think we all experience something called alarm fatigue,” Eiting said. “We set up so many bells and whistles to go off in different scenarios that staff can hear something and immediately reach for the silence button without thinking about why it’s going off and what might need to be changed clinically. And in many cases, there isn’t anything that needs to be changed, and that makes people even more likely to ignore the alarms.”

SOURCE: bit.ly/33qgKqh American Journal of Emergency Medicine, online July 30,2019.

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