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Objective In this work, we systematically evaluated the reserved alarm sounds of the IEC 60601-1-8 international medical alarm standard to determine when and how they can be totally and partially masked. Background IEC 60601-1-8 gives engineers instruction for creating human-perceivable auditory medical alarms. This includes reserved alarm sounds: common types of alarms where each is a tonal melody. Even when this standard is honored, practitioners still fail to hear alarms, causing practitioner nonresponse and, thus, potential patient harm. Simultaneous masking, a condition where one or more alarms is imperceptible in the presence of other concurrently sounding alarms due to limitations of the human sensory system, is partially responsible for this. Methods In this research, we use automated proof techniques to determine if masking can occur in a modeled configuration of medical alarms. This allows us to determine when and how reserved alarm sound can mask other reserved alarms and to explore parameters to address discovered problems. Results We report the minimum number of other alarm sounds it takes to both totally and partially mask each of the high-, medium-, and low-priority alarm sounds from the standard. Conclusions Significant masking problems were found for both the total and partial masking of high-, medium-, and low-priority reserved alarm sounds. Application We show that discovered problems can be mitigated by setting alarm volumes to standard values based on priority level and by randomizing the timing of alarm tones.

Copyright @ Public Library of Science ; Introduction Reducing preventable readmissions among Medicare beneficiaries is an effective way to not only reduce the exorbitantly rising cost in healthcare but also as a measure to improve the quality of patient care. Many of the previous efforts in reducing readmission rate of patients have not been very successful because of ill-defined quality measures, improper data collection methods and lack of effective strategies based on data driven solutions. Methods In this study, we analyzed the readmission data of patients for six major diseases including acute myocardial infarction (AMI), heart failure (HF), coronary artery bypass graft (CABG), pneumonia (PN), chronic obstructive pulmonary disease (COPD), and total hip arthroplasty and/or total knee arthroplasty (THA/TKA) from the Center for Medicare and Medicaid Read- missions Reduction Program (HRRP) program for the period 2012–2015 in context with the ownership structure of the hospitals. Results Our analysis demonstrates that the readmission rates of patients were statistically higher in proprietary (for profit) hospitals compared to the government and non-profit hospitals which was independent of their geographical distribution across all six major diseases. Conclusion This finding we believe has strong implications for policy makers to mitigate any potential risks in the quality of patient care arising from unintended revenue pressure in healthcare institutions.

Objective This research investigated whether the psychoacoustics of simultaneous masking, which are integral to a model-checking-based method, previously developed for detecting perceivability problems in alarm configurations, could predict when IEC 60601-1-8-compliant medical alarm sounds are audible. Background The tonal nature of sounds prescribed by IEC 60601-1-8 makes them potentially susceptible to simultaneous masking: where concurrent sounds render one or more inaudible due to human sensory limitations. No work has experimentally assessed whether the psychoacoustics of simultaneous masking accurately predict IEC 60601-1-8 alarm perceivability. Method In two signal detection experiments, 28 nursing students judged whether alarm sounds were present in collections of concurrently sounding standard-compliant tones. The first experiment used alarm sounds with single-frequency (primary harmonic) tones. The second experiment's sounds included the additional, standard-required frequencies (often called subharmonics). T tests compared miss, false alarm, sensitivity, and bias measures between masking and nonmasking conditions and between the two experiments. Results Miss rates were significantly higher and sensitivity was significantly lower for the masking condition than for the nonmasking one. There were no significant differences between the measures of the two experiments. Conclusion These results validate the predictions of the psychoacoustics of simultaneous masking for medical alarms and the masking detection capabilities of our method that relies on them. The results also show that masking of an alarm's primary harmonic is sufficient to make an alarm sound indistinguishable. Application Findings have profound implications for medical alarm design, the international standard, and masking detection methods.