Informing Healthcare Alarm Design and Use: A Human Factors Cross-Industry Perspective

Zoe M. Pruitt, MA, MedStar Health National Center for Human Factors in Healthcare

Zoe M. Pruitt is a senior human factors specialist at the MedStar Health National Center for Human Factors in Healthcare.

Lucy S. Bocknek, MS, OTR/L, MedStar Health National Center for Human Factors in Healthcare

Lucy S. Bocknek is a human factors and safety scientist at the MedStar Health National Center for Human Factors in Healthcare.

Deanna-Nicole C. Busog, BS, MedStar Health National Center for Human Factors in Healthcare

Deanna-Nicole C. Busog is a senior research associate at the MedStar Health National Center for Human Factors in Healthcare.

​Patricia A. Spaar, MSN, RN, MedStar Health National Center for Human Factors in Healthcare

Patricia A. Spaar is a senior clinical safety and research specialist at the MedStar Health National Center for Human Factors in Healthcare.

Arianna P. Milicia, BS, MedStar Health National Center for Human Factors in Healthcare

Arianna P. Milicia is a research associate at the MedStar Health National Center for Human Factors in Healthcare.

Jessica L. Howe, MA, MedStar Health National Center for Human Factors in Healthcare

Jessica L. Howe is a research scientist and system safety specialist at the MedStar Health National Center for Human Factors in Healthcare.

Ella S. Franklin, MSN, RN,MedStar Health National Center for Human Factors in Healthcare

Ella S. Franklin is the senior director of nursing research and systems safety science at the MedStar Health National Center for Human Factors in Healthcare.

Seth Krevat, MD, MedStar Health National Center for Human Factors in Healthcare

Seth Krevat is the senior medical director at the MedStar Health National Center for Human Factors in Healthcare and an assistant professor at Georgetown University School of Medicine.

Rebecca Jones, MBA, RN,* Patient Safety Authority

Rebecca Jones (rebejones@pa.gov)​ is director of Data Science and Research at the Patient Safety Authority and founder and director of the PSA’s Center of Excellence for Improving Diagnosis. 

Raj M. Ratwani, PhD, MedStar Health National Center for Human Factors in Healthcare

Raj M. Ratwani is the director of the MedStar Health National Center for Human Factors in Healthcare, vice president of scientific affairs at the MedStar Health Research Institute, and an associate professor at Georgetown University School of Medicine.​

Abstract

​ ​Background
​Alarms are signals intended to capture and direct human attention to a potential issue that may require monitoring, assessment, or intervention and play a critical safety role in high-risk industries. Healthcare relies heavily on auditory and visual alarms. While there are some guidelines to inform alarm design and use, alarm fatigue and other alarm issues are challenges in the healthcare setting. Automotive, aviation, and nuclear industries have used the science of human factors to develop alarm design and use guidelines. These guidelines may provide important insights for advancing patient safety in healthcare.

Methods
We identified documents containing alarm design and use guidelines from the automotive, aviation, and nuclear industries that have been endorsed by oversight agencies. These guidelines were reviewed by human factors and clinical experts to identify those most relevant to healthcare, qualitatively analyze the relevant guidelines to identify meaningful topics, synthesize the guidelines under each topic to identify key commonalities and differences, and describe how the guidelines might be considered by healthcare stakeholders to improve alarm design and use.

Results
A total of 356 guidelines were extracted from industry documents (2012–present) and 327 (91.9%) were deemed relevant to healthcare. A qualitative analysis of relevant guidelines resulted in nine distinct topics: Alarm Reduction, Appropriateness, Context-Dependence, Design Characteristics, Mental Model, Prioritization, Specificity, Urgency, and User Control. There were several commonalities, as well as some differences, across industry guidelines. The guidelines under each topic were found to inform the auditory or visual modality, or both. Certain guidelines have clear considerations for healthcare stakeholders, especially technology developers and healthcare facilities.

Conclusion
Numerous guidelines from other high-risk industries can inform alarm design and use in healthcare. Healthcare facilities can use the information presented as a framework for working with their technology developers to appropriately design and modify alarming technologies and can evaluate their clinical environments to see how alarming technologies might be improved.