Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue.
OBJECTIVE
(1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification.


BACKGROUND
Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue.


METHODS
Simulation, HFE, and computer science experts created a novel simulation methodology to study alarm fatigue. Featuring multiple interconnected simulated patient scenarios with scripted timeline, "distractor" patient care tasks, and triggered true and false alarms, the methodology incorporated objective metrics to assess provider and system performance. Developed materials were implemented during institutional review board-approved study sessions that assessed and compared an experimental multiparametric alerting system with a standard monitor telemetry system for subject response, use characteristics, and end-user feedback.


RESULTS
A four-patient simulation setup featuring objective metrics for participant task-related performance and response to alarms was developed along with accompanying structured HFE assessment (questionnaire and interview) for monitor systems use testing. Two pilot and four study sessions with individual nurse subjects elicited true alarm and false alarm responses (including diversion from assigned tasks) as well as nonresponses to true alarms. In-simulation observation and subject questionnaires were used to test the experimental system's approach to suppressing false alarms and alerting providers.


CONCLUSIONS
A novel investigative methodology applied simulation and HFE techniques to replicate and study alarm fatigue in controlled settings for systems assessment and experimental research purposes.
1 Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA.|2 Lifespan Medical Simulation Center, Providence, RI, USA.
Leo
L
Kobayashi
3 Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|4 Red Forest Consulting, Ann Arbor, MI, USA.
John W
JW
Gosbee
5 Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA.
Derek L
DL
Merck
D000046:Academic Medical Centers; D001305:Auditory Fatigue; D056902:Clinical Alarms / Q000592:standards; D003198:Computer Simulation; D064648:Critical Care Nursing / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D006804:Ergonomics; D006801:Humans; D007407:Interviews as Topic; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D009622:Noise; D009726:Nurses; D061214:Patient Safety; D010865:Pilot Projects; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D013686:Telemetry
academic research; acute care; emergency; environmental design; equipment design; human factors; patient safety; research methodology; research tools; research-informed design