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4/25/2011
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Is Flood Of Medical Alerts Harming Patients?

Alarms from increasingly sensitive health IT could be desensitizing clinicians to signs of patient danger.

If you've spent any time in a hospital, you know how noisy it can be, with all sorts of beeping and buzzing from monitors and computers signaling potential danger. Couple these alerts with text messages and flashing alerts from electronic health records (EHRs), computerized physician order entry (CPOE) systems, and programs to remind nurses and doctors to check patients' IDs, drug orders, lab results, etc., and you're faced with a huge wall of white noise.

The problem is likely to get even more disruptive as clinicians increasingly deploy telehealth applications to help monitor chronically ill patients at home for signs of trouble.

The surround sound of alerts and alarms emitting from dozens of devices hooked onto dozens of patients each day is causing many clinicians to ignore the alerts, even shutting them off without adequately investigating whether an issue is life threatening or just another false alarm.

Unfortunately, this alarm fatigue has lead to several patient deaths. The Boston Globe in recent months has followed the issue, especially as it relates to 15 recent tragic deaths of patients in New England hospitals.

Among those fatal cases, clinicians failed to respond to a heart monitoring alert that sounded for more than an hour to warn of a low battery. The patient's heart failed, but by that time, so did the monitor battery, and no emergency alarm sounded to alert clinicians of the medical crisis.

Getting The FDA Involved

The attention on these New England cases, along with more than 200 other suspected alarm fatigue-related incidents in other U.S. hospitals, has prompted the Joint Commission, the independent national organization that accredits U.S. hospitals, to renew its focus on the issue.

The commission is bringing its concerns about alarm fatigue to the Food and Drug Administration. "We've had contact with the FDA to meet around the issues," said Dr. Paul Schyve, senior VP of healthcare improvement at the Joint Commission in an interview.

Schyve hopes that the combined influence of both groups can help persuade healthcare professionals and medical device makers to address the problem with better work habits and improved products and standards, especially since the Commission accredits healthcare organizations and the FDA approves medical devices.

And address this issue they must. Research shows that the alerts are getting out of control.

A new study, "Understanding the Management of Electronic Test Result Notifications in the Outpatient Setting" published April 12 in BMC Medical Informatics and Decision Making, found that among the biggest problems reported by clinicians who use EHRs is the inordinate number of alerts, which can be as high as 150 in one day.

As for the type of alarm fatigue related to medical devices, that issue had been on a short list of Joint Commission patient safety goals for hospitals a few years ago, Schyce said. "But the problem seemed like it was being mitigated by hospitals, so we decided alarm fatigue didn't need the spotlight as much as other patient safety issues," he said.

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