Sound the Alarm – Or Perhaps Not

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If you live or work in a city, you’re likely used to the everyday sounds of car horns honking, jackhammers drilling, sirens ringing and trains rumbling. If you’re like me, you may have developed the ability to tune out these noises without even knowing it. So how do we know which sounds we really need to pay attention to?

That’s the question being asked in hospitals. With so many audible alarms on patient units, clinicians can become desensitized and fail to respond when an emergency arises. And the constant noise of alarms certainly doesn’t make for a restful patient experience either.

In 2015, we found that up to 490 unique alarms sounded per patient bed per day in certain units at the Brigham. That’s roughly 20 alarms per hour. About 75 percent of them were non-critical.

To address this, we conducted a six-month pilot to reduce the number of audible alarms and ensure that alarms indicating an urgent medical need would be heard.

Here are a few examples of the changes we made:

  • Widened the parameters for the high and low heart rate alarm settings to decrease the number of alarms that do not require action from a care provider.
  • Tailored alarms to the needs of each patient care unit. For example, the needs of patients in the Medical Intensive Care Unit are very different from the needs of postpartum patients, and the alarms have been programmed accordingly.
  • Implemented nursing practice changes to reduce alarms caused by poor contact of the monitor with the patient’s skin, such as the monitors that measure oxygen levels or record the electrical activity of the heart.

These efforts resulted in a 70 percent reduction of alarms across the hospital, which made the hospital safer by improving the care team’s ability to hear critical alarms and increased patient satisfaction as well.

Since then, we have heard from providers who said the units were significantly less noisy, allowing them to hear the alarms sounding for a critically-important condition. Patients reported improved satisfaction due to fewer noises, less stress about what the alarms meant and fewer interruptions.