Suchergebnisse

Objective Address the alarm problem by redesigning, reorganizing, and reprioritizing to better discriminate alarm sounds and displays in a hospital. Background Alarms in hospitals are frequently misunderstood, disregarded, and overridden. Method Discovery-oriented, intervention, and translational studies were conducted. Study objectives and measures varied, but had the shared goals of increasing positive predictive value (PPV) of critical alarms by reducing low-PPV alarms in the background, prioritizing alarms, redesigning alarm sounds to increase information content, and transparently conveying who initiated alarms. An alarm ontology was iteratively generated and refined until consensus was achieved. Results The ontology distinguishes five levels of urgency that incorporate likely PPV, three categories for who initiates the alarm (hospital staff, patient, or machine), whether it is clinical or technical, and clinical functions. Conclusion This unique collaboration allowed us to make progress on the alarm problem by making unintuitive leaps, avoiding common missteps, and refuting conventional healthcare approaches. Application Hospitals can consistently redesign, reorganize, reprioritize, and better discriminate alarms by priority, PPV, and content to reduce nurse response times.

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.