Sage Journals: Discover world-class research

Abstract

Objective

A study of auditory displays for simulated patient monitoring compared the effectiveness of two sound categories (alarm sounds indicating general risk categories from international alarm standard IEC 60601-1-8 versus event-specific sounds according to the type of nursing unit) and two configurations (single-patient alarms versus multi-patient sequences).

Background

Fieldwork in speciality-focused high dependency units (HDU) indicated that auditory alarms are ambiguous and do not identify which patient has a problem. We tested whether participants perform better using auditory displays that identify the relevant patient and problem.

Method

During simulated patient monitoring of four patients in a respiratory HDU, 60 non-clinicians heard either (a) IEC risk categories as single-patient alarm sounds, (b) event-specific categories as single-patient alarm sounds, (c) IEC risk categories in multi-patient sequences or (d) event-specific categories in multi-patient sequences. Participants performed a perceptual-motor task while monitoring patients; after detecting abnormal events, they identified the patient and the event.

Results

Participants hearing multi-patient sequences made fewer wrong patient identifications than participants hearing single-patient alarms. Advantages of event-specific categories emerged when IEC risk category sounds indicated more than one potential event. Even when IEC and event-specific sounds indicated the same unique event, spearcons supported better event identification than did auditory icon sounds.

Conclusion

Auditory displays that unambiguously convey which patient is having what problem dramatically improve monitoring performance in a preclinical HDU simulation.

Application

Time-compressed speech assists development of detailed risk categories needed in specific HDU contexts, and multi-patient sound sequences allow multiple patient wellbeing to be monitored.

Keywords

medical devices and technologies critical care speech perception auditory displays anaesthesiology and perioperative care

Get full access to this article

View all access options for this article.

References

Atyeo

Sanderson

P. M.

(2015). Comparison of the identification and ease of use of two alarm sound sets by critical and acute care nurses with little or no music training: A laboratory study. Anaesthesia, 70, 818–827. https://doi.org/10.1111/anae.13020

Bennett

C. L.

Dudaryk

Crenshaw

Edworthy

McNeer

(2019). Recommendation of new medical alarms based on audibility, identifiability, and detectability in a randomized, simulation-based study. Critical Care Medicine, 47, 1050–1057. https://doi.org/10.1097/ccm.0000000000003802

Block

F. E.

Rouse

J. D.

Hakala

Thompson

C. L.

(2000). A proposed new set of alarm sounds which satisfy standards and rationale to encode source information. Journal of Clinical Monitoring and Computing, 16, 541–546. https://doi.org/10.1023/A:1011471607530

Cvach

(2012). Monitor alarm fatigue: An intergrative review. Biomedical Instrumentation & Technology, 46, 268–277. https://doi.org/10.2345/0899-8205-46.4.268

Davidson

Ryu

Y. J.

Brecknell

Loeb

R. G.

Sanderson

(2019). The impact of concurrent linguistic tasks on participants' identification of spearcons. Applied Ergonomics, 81, Article 102895. https://doi.org/10.1016/j.apergo.2019.102895

Deschamps

M.-L. F. A.

(2022). Evaluating advanced auditory display concepts to support nursing work in acute and critical care contexts. [In preparation]. PhD. The University of Queensland.

Deschamps

M.-L. F. A.

Sanderson

P. M.

(2021). Nurses’ use of auditory alarms and alerts in high dependency units: A field study. Applied Ergonomics , 96, Article 103475. DOI: 10.1016/j.apergo.2021.103475

Dingler

Lindsay

Walker

B. N.

(2008). Learnability of sound cues for environmental features: Auditory icons, earcons, spearcons, and speech. Proceedings of the 14th International Conference on Auditory Displays. Paris, France, 1–6.

Edworthy

McNeer

R. R.

Bennett

C. L.

Dudaryk

McDougall

S. J. P.

Schlesinger

J. J.

Bolton

M. L.

Edworthy

J. D. R.

Ozcan

Boyd

A. D.

Reid

S. K. J.

Rayo

M. F.

Wright

M. C.

Osborn

(2018). Getting better hospital alarm sounds into a global standard. Ergonomics in Design, 26, 4–13. https://doi.org/10.1177/1064804618763268

10.

Edworthy

J. R

Parker

C. J.

Martin

E. V.

(2022). Discriminating between simulteneous audible alarms is easier with auditory icons. Applied Ergonomics, 99, 103609. https://doi.org/10.1016/j.apergo.2021.103609

11.

Edworthy

Reid

McDougall

Edworthy

Hall

Bennett

Khan

Pye

(2017). The recognizability and localizability of auditory alarms: Setting global medical device standards. Human Factors, 59, 1108–1127. https://doi.org/10.1177/0018720817712004

12.

Fitzgerald

Rayo

M. F.

Reynolds

M. E.

Abdel-Rasoul

Moffatt-Bruce

S. D.

(2019). The importance of testing sets of clinical alarm sounds and navigating tradeoffs to translate research findings into implementation. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 8, 67–71. https://doi.org/10.1177/2327857919081015

13.

Graham

K. C.

Cvach

(2010). Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care , 1935, 28–34. quiz. https://doi.org/10.4037/ajcc2010651

14.

Hart

S. G.

Staveland

L. E.

(1988). Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research. Advances in Psychology, 52, 138–183.

15.

Hickling

Brecknell

Loeb

R. G.

Sanderson

(2017). Using a sequence of earcons to monitor multiple simulated patients. Human Factors, 59, 268–288. https://doi.org/10.1177/0018720816670986

16.

Hoffmann

J. P.

(2004). Generalized linear models: An applied approach. Pearson A and B.

17.

IEC 60601-1-8:2006 (2006). International Standard IEC 60601-1-8:2006. Medical electrical equipment - Part 1-8: General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems. International Electrotechnical Commission (IEC).

18.

IEC60601-1-2006/AMD2:2000 (2020). International Standard IEC 60601-1-8:2006/AMD2:2020. Medical electrical equipment - Part 1-8: General requirements for basic safety and essential performance: General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems. International Electrotechnical Commission (IEC).

19.

Janata

Edwards

W. H.

(2013). A novel sonification strategy for auditory display of heart rate and oxygen saturation changes in clinical settings. Human Factors, 55, 356–372. https://doi.org/10.1177/0018720812455433

20.

S. Y. W.

Tang

T. L.

Hickling

Yau

Brecknell

Sanderson

P. M.

(2017). Spearcons for patient monitoring: Laboratory investigation comparing earcons and spearcons. Human Factors, 59, 765–781. https://doi.org/10.1177/0018720817697536

21.

S. Y. W.

Tse

M. K.

Brecknell

Sanderson

P. M.

(2019). Spearcon sequences for monitoring multiple patients: Laboratory investigation comparing two auditory display designs. Human Factors, 61, 288–304. https://doi.org/10.1177/0018720818797502

22.

McDougall

Edworthy

Sinimeri

Goodliffe

Bradley

Foster

(2020). Searching for meaning in sound: Learning and interpreting alarm signals in visual environments. Journal of Experimental Psycholoy: Applied, 26, 89–107. https://doi.org/10.1037/xap0000238

23.

McNeer

R. R.

Horn

D. B.

Bennett

C. L.

Edworthy

J. R.

Dudaryk

(2018). Auditory icon alarms are more accurately and quickly identified than current standard melodic alarms in a simulated clinical setting. Anesthesiology, 129, 58–66. https://doi.org/10.1097/ALN.0000000000002234

24.

Meek

G. E.

Ozgur

Dunning

(2007). Small F-ratios: Red flags in the linear model. Journal of Data Science, 5, 199–215. https://doi.org/10.6339/JDS.2007.05(2).339

25.

Nygren

T. E.

(1991). Psychometric properties of subjective workload measurement techniques: Implications for their use in the assessment of perceived mental workload. Human Factors, 33, 17–33. https://doi.org/10.1177/001872089103300102

26.

Patterson

E. S.

Rayo

M. F.

Edworthy

J. R.

Moffatt-Bruce

S. D.

(2021). Applying human factors engineering to address the telemetry alarm problem in a large medical center. Human Factors, 64, 126–142. https://doi.org/10.1177/00187208211018883

27.

Petocz

Keller

P. E.

Stevens

C. J.

(2008). Auditory warnings, signal-referent relations, and natural indicators: Re-thinking theory and application. Journal of Experimental Psychology-Applied, 14, 165–178. https://doi.org/10.1037/1076-898x.14.2.165

28.

Rayo

M. F.

Moffatt-Bruce

S. D.

(2015). Alarm system mangement: Evidence-based guidance encouraging direct measurement of informativeness to improve alarm response. BMJ Quality and Safety, 24(4), 282–286. https://doi.org/10.1136/bmjqs-2014-003373

29.

Rayo

M. F.

Patterson

E. S.

Abdel-Rasoul

Moffatt-Bruce

S. D.

(2019). Using timbre to improve performance of larger auditory alarm sets. Ergonomics, 62(12), 1617–1629. https://doi.org/10.1080/00140139.2019.1676473

30.

Roche

T. R.

Braun

Ganter

Meybohm

Herrmann

Zacharowski

Faimann

F. J.

Piekarski

Spahn

D. R.

Noethinger

C. B.

Tscholl

D. W.

Said

(2021). Voice alerting as a medical alarm modality holds untapped potential for next-generation patient monitoring - a randomised international multi-centre trial. British Journal of Anaesthesia, 127, 769–777. https://doi.org/10.1016/j.bja.2021.07.015

31.

Sanderson

Brecknell

Leong

Klueber

Wolf

Hickling

Tang

T.-L.

Bell

S. Y. W.

Loeb

R. G.

(2019). Monitoring vital signs with time-compressed speech. Journal of Experimental Psychology: Applied, 25, 647–673. https://doi.org/10.1037/xap0000217

32.

Sowan

A. K.

Gomez

T. M.

Tarriela

A. F.

Reed

C. C.

Paper

B. M.

(2016). Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: A pilot project. JMIR Human Factors, 3, Article e1. https://doi.org/10.2196/humanfactors.5098

33.

Srbinovska

Salisbury

I. S.

Loeb

R. G.

Sanderson

P. M.

(2020). Spearcon compression levels influence the gap in comprehension between untrained and trained listeners. Journal of Experimental Psychology: Applied, 27, 69–83. https://doi.org/10.1037/xap0000330

34.

Walker

B. N.

Lindsay

Nance

Nakano

Palladino

D. K.

Dingler

Jeon

(2013). Spearcons (speech-based earcons) improve navigation performance in advanced auditory menus. Human Factors, 55, 157–182. https://doi.org/10.1177/0018720812450587

35.

Webster

Sanderson

P. M.

(2021). The need for a new paradigm in the design of alarms for patient monitors and medical devices [Editorial]. British Journal of Anaesthesia, 127, 677–680. https://doi.org/10.1016/j.bja.2021.08.001

36.

Wee

A. N.

Sanderson

P. M.

(2008). Are melodic medical equipment alarms easily learned? Anesthesia and Analgesia, 106, 501–508. https://doi.org/10.1213/01.ane.0000286148.58823.6c

37.

Woods

D. D.

(1995). The alarm problem and directed attention in dynamic fault management. Ergonomics, 38(11), 2371–2393. https://doi.org/10.1080/00140139508925274

38.

Wright

M. C.

Radcliffe

Janzen

Edworthy

Reese

Segall

(2020). Organizing audible alarm sounds in the Hospital: A card-sorting study. IEEE Transactions on Human-Machine Systems, 50, 623–627. https://doi.org/10.1109/thms.2020.3019363

39.

Xiao

Seagull

F. J.

Nieves-Khouw

Barczak

Perkins

(2004). Organizational-historical analysis of the “failure to respond to alarm” problems. IEEE Transactions on Systems, Man, and Cybernetics, 34, 772–777. https://doi.org/10.1109/TSMCA.2004.836781

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.09 MB

Auditory Sequences Presented With Spearcons Support Better Multiple Patient Monitoring Than Single-Patient Alarms: A Preclinical Simulation

Abstract

Objective

Background

Method

Results

Conclusion

Application

Keywords

Get full access to this article

References

Supplementary Material