AAMI: Alarm fatigue, IT, interoperability among top 10 biomed challenges
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The information stemmed from a research survey commissioned in November 2010 and conducted by Stratton Research via email, with questions sent to more than 2,500 hospital biomedical technicians and clinical engineers. There were 418 responses, and the results were published in the March/April issue of the Biomedical Instrumentation & Technology. Clinical engineers and hospital professionals discussed the findings on June 27 at the AAMI conference.
The top 10 challenges were:
1. Interfacing between devices and information systems
2. Maintaining computerized IT systems
3. Managing alarms
4. Maintaining and processing endoscopes
5. Broken connectors
6. Wireless management
7. Battery management
8. Problems with patient monitors
9. Problems with dialysis equipment
10. Managing the radiation dose from CT
“In terms of solutions to these challenges, clinical engineering veterans and other professionals hit the same broad themes: better education and training, stronger and communication and cooperation among departments, and often a need for standards,” said Paul W. Kelley, CBET, of Washington Hospital Healthcare System in Fremont, Calif.
The successful implementation of interoperability requires defined objectives and measurable goals, noted Carol Davis-Smith, CCE, Premier Healthcare Alliance in Charlotte, N.C., as well as a complete and well-maintained physical inventory of the applicable items included in the network. When implementing interoperable devices, Davis-Smith recommended prioritizing and making decisions that are data-driven.
“What we’re finding out there in the community, is that one, our basic CMO mass inventory is not clean. We need to get that cleaned up, and the reason being, because we need to have IT collect this really granular data about each of those individual devices, what can talk and what cannot talk, to what extent does it talk and how does it talk,” Davis-Smith said. “Bringing this level of granularity might be an ice-breaker in the IT department.”
“[From the survey,] we learned that IT plays a huge role in biomedical engineering, as three of the top 10 challenges are IT-related,” Kelley said. "The IT department, clinical engineers, clinicians and vendors have to work together. Healthcare is most definitely a team sport.”
According to AAMI, Robert H. Stiefel, president of Baltimore-based RHS Biomedical Consulting, recommended training and education to help solve the interfacing problem, and others recommended fostering a strong relationship with IT departments.
Related to interoperability, and also strong focus of Monday’s discussion, was alarm management. Managing alarms has become a critical issue—gaining national press exposure with stories in The New York Times and The Washington Post—as hospitals are attempting to manage alarm fatigue and high frequencies of alarms sounding from too many indistinguishable systems.
“In terms of the top 10 medical device challenges, it really interacts with so many of the other challenges: interfacing, computer updates, broken connectors, patient monitors,” said J. Tobey Clark, CCE, of the University of Vermont in Burlington. “All of those other hazards directly impact clinical alarms.”
Clark said that sounds are only part of the clinical alarm problem. Humans have been found not to be able to recognize more than six different alarm sounds, he said, and have difficulty distinguishing the difference between high- and low-priority alarms.
“This clinical alarm problem is very complex,” he said. “The stumbling block is human limitations.”
Clark said that alarms, averaging between 200 and 600 per day at some hospitals, need applied management techniques. New systems should not necessarily be set with the default alarm settings that come with new equipment. He recommended getting below 100 patient alarms per day, or even as low as four per patient, he said. It’s been reported that the default alarm settings on monitors are not appropriate, and perhaps, overkill.
“Because it’s a complex problem, you need a complex solution,” Clark said. “We need a multi-disciplinary approach to resolve this problem. False alarms and nuisance alarms were by far the biggest problems that lead to alarm fatigue.”
The issue will be the focus of an upcoming AAMI summit in Herndon, Va., Oct. 4-5. For more information on alarm fatigue or to register for the summit, click here.