So, when we had our kid we basically lived with alarms going off, semi-continuously, for 3 days. My wife was on continuous monitoring and the things would slip off all the time, or the hourly...
So, when we had our kid we basically lived with alarms going off, semi-continuously, for 3 days. My wife was on continuous monitoring and the things would slip off all the time, or the hourly blood pressure would alarm or…
Somewhere on day 2, I was holding the kiddo and yet another alarm went off. I didn’t think anything of it. I didn’t even think it was our room.
The nurse busted in 30s later because apparently the baby alarm they put around the kid’s foot was loose and lost contact with skin. She asked “didn’t we hear the alarm?”
Alert fatigue. It's been a documented issue for ages. Unfortunately who gets to decide what warrants the doctors attention has a lot of mixed incentives. The people who create the medical device...
Alert fatigue. It's been a documented issue for ages. Unfortunately who gets to decide what warrants the doctors attention has a lot of mixed incentives. The people who create the medical device need to design it to certain specifications, which often require some kind of audible alert when values are clinically important. So you end up with everything making a beep. Older devices might have beeping to let you know it's on and working, because someone decided that was important. I believe newer devices are required to have a "silence" functionality for the "I'm on" beeps.
But ultimately it's not a problem we can easily resolve except by mandating that all new technology meet certain criteria and then setting up the devices to just not be so annoying. Soon enough we'll likely have some sort of tuned ML that can notify clinicians when it's important to come check in on the patient, and maybe we'll no longer have to suffer from alert fatigue. But more than likely medical devices will take another 20+ years to catch up and phase out all the old beeping machines before we finally get a sense of peace and quiet.
The part I find truly offensive about the excess of monitors/noise in ICUs is that the various pieces of equipment aren’t glued together in any sensible way and keep very little history. A lot of...
The part I find truly offensive about the excess of monitors/noise in ICUs is that the various pieces of equipment aren’t glued together in any sensible way and keep very little history.
A lot of equipment just relies on noise to indicate there’s an issue happening but doesn’t save any record of it for review. Patient is tachycardic/arrhythmic for a few minutes, but the nurse isn’t there to see it? Too bad - out of sight, out of mind.
It’s still standard practice for a nurse to check in every few hours and chart a single HR/BP measurement manually into Epic. The sensors are pulling multiple readings per second, and maybe three of those measurements per day get saved in the EMR. Crazypants.
(Obligatory disclosure that I work in this space.)
We visited a friend that is a nurse at a hospital in Japan a few years ago, while she was on break in the hospital, and the first thing I noticed was how quiet and calm the entire floor was. Now,...
We visited a friend that is a nurse at a hospital in Japan a few years ago, while she was on break in the hospital, and the first thing I noticed was how quiet and calm the entire floor was. Now, this could have just been one floor, or that particular moment, or that hospital, or some other fluke. But there was the incessant beeping and whir of machines that I am accustomed to here in the US. I asked about it, through my wife who speaks Japanese and is a nurse in the US, and the answer I got was that at least in media, US hospitals seemed way too loud and frenzied. Again, that’s media so not real life, so it could mean nothing. But I still remember how quiet it was on that floor (and it wasn’t like a recovery floor, I think it was cardiac).
The kitchens in McDonald’s and other fast food places have the same soundscape as US hospitals, too.
My best friend's father passed away in a hospital a few years ago. We were lucky to go say goodbye when we could, but even in the ward we were in, with so many people expected to code, it was so...
My best friend's father passed away in a hospital a few years ago. We were lucky to go say goodbye when we could, but even in the ward we were in, with so many people expected to code, it was so loud. I have sensory issues, and high-pitched noises set me on edge pretty easily, I couldn't keep calm when saying goodbye to my second dad because of how much noise it was.
I ended up in the hospital a couple years ago with hypertension (crazy high blood pressure) due to a then-undiagnosed kidney problem. I was admitted for 5 days while medications brought down my...
I ended up in the hospital a couple years ago with hypertension (crazy high blood pressure) due to a then-undiagnosed kidney problem. I was admitted for 5 days while medications brought down my blood pressure so a biopsy could safely be taken. Every 30 minutes, 24 hours a day, the blood pressure cuff would measure me and then HIGH BLOOD PRESSURE RED ALERT DEFCON 1 alarm would go off. Sleep was hard to come by...
So, when we had our kid we basically lived with alarms going off, semi-continuously, for 3 days. My wife was on continuous monitoring and the things would slip off all the time, or the hourly blood pressure would alarm or…
Somewhere on day 2, I was holding the kiddo and yet another alarm went off. I didn’t think anything of it. I didn’t even think it was our room.
The nurse busted in 30s later because apparently the baby alarm they put around the kid’s foot was loose and lost contact with skin. She asked “didn’t we hear the alarm?”
I laughed.
When everything’s urgent, nothing is.
Alert fatigue. It's been a documented issue for ages. Unfortunately who gets to decide what warrants the doctors attention has a lot of mixed incentives. The people who create the medical device need to design it to certain specifications, which often require some kind of audible alert when values are clinically important. So you end up with everything making a beep. Older devices might have beeping to let you know it's on and working, because someone decided that was important. I believe newer devices are required to have a "silence" functionality for the "I'm on" beeps.
But ultimately it's not a problem we can easily resolve except by mandating that all new technology meet certain criteria and then setting up the devices to just not be so annoying. Soon enough we'll likely have some sort of tuned ML that can notify clinicians when it's important to come check in on the patient, and maybe we'll no longer have to suffer from alert fatigue. But more than likely medical devices will take another 20+ years to catch up and phase out all the old beeping machines before we finally get a sense of peace and quiet.
The part I find truly offensive about the excess of monitors/noise in ICUs is that the various pieces of equipment aren’t glued together in any sensible way and keep very little history.
A lot of equipment just relies on noise to indicate there’s an issue happening but doesn’t save any record of it for review. Patient is tachycardic/arrhythmic for a few minutes, but the nurse isn’t there to see it? Too bad - out of sight, out of mind.
It’s still standard practice for a nurse to check in every few hours and chart a single HR/BP measurement manually into Epic. The sensors are pulling multiple readings per second, and maybe three of those measurements per day get saved in the EMR. Crazypants.
(Obligatory disclosure that I work in this space.)
We visited a friend that is a nurse at a hospital in Japan a few years ago, while she was on break in the hospital, and the first thing I noticed was how quiet and calm the entire floor was. Now, this could have just been one floor, or that particular moment, or that hospital, or some other fluke. But there was the incessant beeping and whir of machines that I am accustomed to here in the US. I asked about it, through my wife who speaks Japanese and is a nurse in the US, and the answer I got was that at least in media, US hospitals seemed way too loud and frenzied. Again, that’s media so not real life, so it could mean nothing. But I still remember how quiet it was on that floor (and it wasn’t like a recovery floor, I think it was cardiac).
The kitchens in McDonald’s and other fast food places have the same soundscape as US hospitals, too.
My best friend's father passed away in a hospital a few years ago. We were lucky to go say goodbye when we could, but even in the ward we were in, with so many people expected to code, it was so loud. I have sensory issues, and high-pitched noises set me on edge pretty easily, I couldn't keep calm when saying goodbye to my second dad because of how much noise it was.
I ended up in the hospital a couple years ago with hypertension (crazy high blood pressure) due to a then-undiagnosed kidney problem. I was admitted for 5 days while medications brought down my blood pressure so a biopsy could safely be taken. Every 30 minutes, 24 hours a day, the blood pressure cuff would measure me and then HIGH BLOOD PRESSURE RED ALERT DEFCON 1 alarm would go off. Sleep was hard to come by...