Alarm Fatigue in the Emergency Department: A Multicenter, Mixed-Method Study of Monitor Alarms

Abstract

Objectives

Describe the frequency and pattern of monitor alarms in the emergency department (ED), in combination with exploring the staff’s experience of alarms and alarm fatigue.

Methods

This was a multicenter, mixed-method study of observational monitor alarms and semistructured staff interviews with inductive qualitative content analysis from 3 EDs in Sweden. The primary measures were alarm frequency and confirmation times. Quantile regression was used to analyze the association between alarms and confirmation times.

Results

In total, 396,011 alarms were registered during the data collection period, or 1 alarm every 30 seconds in the urban and academic centers and every 120 seconds in the rural hospital, on average. Median confirmation times were 11 seconds for high severity alarms (IQR, 5-33) and 132 seconds for low severity alarms (IQR, 15-878). This increased by 1 second when alarms per hour increased by 128 (95% CI, 67-1000; P = .03) and 4.8 (95% CI, 3.1-11.6; P = .001) for high and low severity alarms, respectively. The content analysis from 20 interviews revealed 3 main aspects that influenced alarm management in the ED, with implications on alarm fatigue: unclear or broad indications for monitoring relying on health care staff knowledge and experience; physical layout, alarm responsibility, and workload in the ED environment; and finally, monitor and patient factors influencing alarm analysis.

Conclusion

ED staff work in an alarm environment prone to alarm fatigue with frequent alarms and several system-related factors that increase the risk of alarm fatigue, which is mitigated by the individual health care worker.