Miller School Selected for Study on Improving Performance of Medical Alarms

The University of Miami Miller School of Medicine has been selected as a research site to help develop the next international standard for medical alarms as part of a project funded by the Association for the Advancement of Medical Instrumentation (AAMI).

“Emergency rooms, operating rooms and intensive care units are very noisy clinical environments, and patients are often connected to many different types of monitoring devices, each with its own alarm sound,” said Richard McNeer, M.D., Ph.D., assistant professor of clinical anesthesiology. “Our goal is to simulate these intense clinical settings at UM in order to help develop more effective, evidence-based alarm standards.”

McNeer, who has a secondary appointment in biomedical engineering and is widely recognized for his acoustical research, leads the Miller School team, which will perform simulation-based experiments on several candidate alarm sets using an $85,000 research award. The research is part of a broader project being performed in collaboration with Plymouth University in the United Kingdom, said McNeer.

“It is amazing how often brilliant ideas come at the intersection of disparate disciplines,” said David A. Lubarsky, M.D., M.B.A., Emanuel M. Papper Professor and Chair of Anesthesiology. “Dr. McNeer’s clinical anesthesia assignment at the Ryder Trauma Center, among the most demanding of acute care clinical environments, inspired a search for more meaningful information from the cacophony of alarms we now tolerate.”

McNeer said the current medical alarm standard was adopted by the International Electrotechnical Commission a decade ago without being tested or validated in clinical settings.

“Unfortunately, numerous studies have shown that the current alarms are not performing well,” he said. “Some devices have adopted the standard which consists of a series of musical tones, while others just beep loudly. When two, three or even more alarms are sounding at the same time, it is difficult for clinicians to determine what is most important for the patient at that moment.”

For example, an infusion pump might sound an alarm when the anesthesia medication in a bag is used up. However, that might be less important than an alarm from a ventilator supporting the patient’s breathing.

“Right now, there is a mismatch between the alarm sounds and the urgency of the situation,” McNeer said. “Also, there is no unified practice for tailoring the alarm sounds for individual patients. For example, a particular heart rate might be normal for one patient but abnormal for another. And this often leads to the sounding of numerous inappropriate and false alarms, which can contribute to the development of alarm fatigue in clinicians. One result is that alarms are often ignored as they become part of the background noise.”

McNeer said high-fidelity simulation will help determine which medical alarms are most effective in alerting clinicians to urgent conditions without being “masked” by background noise in critical care settings.

“In general, a more complex alarm sound is easier to learn and to localize in an ER or ICU environment than a simple beep,” he said. “But additional aspects of a long-term solution may be to centralize alarm processing so that an algorithm or an artificial intelligence application that determines the priority of alarms based on context and the underlying medical events can be implemented.”

McNeer is also co-author of a recent study, “Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study,” in Anesthesia Analgesia, the journal of the International Anesthesia Research Society. The paper’s co-authors, Christopher L. Bennett, Ph.D., research assistant professor of music engineering technology at the University of Miami Frost School of Music, and Roman Dudaryk, M.D., assistant professor of clinical anesthesiology, have collaborated with McNeer in other noise-related studies.

Their new study notes noise in operating rooms can be associated with adverse effects on staff and patient safety. The researchers retrofitted the Miller School’s operating room simulator to produce surround-sound simulations of clinical noise including current standard medical alarms typically encountered during surgeries, and assessed the perceived task load and fatigue in 20 first-year anesthesia residents.

“This study provides evidence that noise during surgery can increase feelings of stress, as measured by perceived task load and fatigue levels, in anesthesiologists,” said McNeer. “It adds to the growing literature pointing to an overall adverse impact of clinical noise on caregivers and patient safety, and it is important that the next set of standard alarms does not ultimately add to this clinical noise.”

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