By Todd Plesko, VP of Product Strategy, Vocera Communications, Inc.
Twitter: @VoceraComm
Load down your computer or phone with memory-hungry programs, and you’ll notice it just doesn’t work as well. It slows down, it freezes up, and the battery wears down at an accelerated rate. Humans are much the same — give them too many competing demands on their mental bandwidth, and they become less and less effective at completing important tasks.
In a hospital setting, this problem can have life and death consequences. Nurses and other clinicians are inundated with so many alarms and alerts throughout the day, that they reach what’s known as “peak cognitive load.” Without guidance about which alarms indicate an emergency and which are “false alarms,” clinicians can become slower at responding to any and all alarms, no matter how acute. The fact is that in today’s hospitals, there are too many notifications that are simply “FYIs” that don’t require an immediate call to action. Since we can’t go out and buy more human memory or processing speed, we need to get rid of some of the irrelevant files in the human hard drive to free up space for what is most important.
Interruption or alarm fatigue is an issue that goes beyond job satisfaction for clinicians. It has become a major target for hospital quality and safety teams as they work to focus limited clinician bandwidth — cognitive load — on the most critical clinical interventions.
Prioritize actionable notifications
Solutions to alarm fatigue should focus on filtering out the FYIs, or non-actionable notifications, from a variety of different systems all vying for clinicians’ limited cognitive load. These systems, including traditional pagers, overhead paging, the electronic health record (EHR), physiologic monitors, nurse call and more are often disconnected because they are from different vendors.
An enterprise strategy to resolve alarm fatigue must be comprehensive, integrated, and multichannel. It should be powered by a single platform that has the capability to capture, filter and prioritize alarms, alerts, text messages and voice communications. It should also know how and to what clinician device this information should be sent. This intelligent triage and routing system will help reduce clinicians’ cognitive load, enabling them to respond more quickly, with clear decision-making processes.
It’s important for healthcare leaders to avoid unintentionally adding to caregivers’ already full plates by implementing piecemeal solutions that require nurses to disrupt their workflows to check an app, or open and close different programs on a computer. The best enterprise communication solutions organize alerts and alarms in one easy view.
Tailor your alarm management approach
While a single, integrated solution can best address the breadth and depth of healthcare organizations’ alarm fatigue challenges, it’s also important to customize the approach to the needs of different units, clinician roles, or even individual caregivers. Here are some ways to tailor alarm management solutions to the unique needs of a hospital:
- Reduce the number of caregivers who receive a given alert to only those who directly care for that patient. Deploy a rules engine to determine the right caregivers to receive a given message, and send notifications directly to their mobile devices
- Give clinicians and staff the flexibility to choose the right device for the role, including a smartphone, hands-free communication badge, VoIP handsets, or workstation. Allow clinicians to create unique ringtones for specific events
- Facilitate quicker care team collaboration and responses to patient events. Route notifications to multiple groups and individuals based on caregiver location, role, title, department, and/or group, and patient room or bed assignment
- Enable caregivers to identify the most urgent patient needs faster by prioritizing events that occur at the same time
- Support clinical decision making: Assemble relevant information from multiple systems such as the EHR, lab values, and ADT data to accompany event notifications
Modernize with interactive solutions
In days past, alarm and event management solutions were designed primarily around pagers, meaning it was a unidirectional communication. Someone would be notified of an event and the workflow ended there. Smartphones and the next generation of alarm and event management middleware platforms are upping the ante by treating workflows more holistically. Specifically, the workflow doesn’t end with a caregiver being notified of an event; in fact, that is only the half-way point now.
The concept of event response is to ask the question, “Now that I have the information, what do I do with it? How can I communicate and collaborate with care team members to affect the best response to this event?” A few intelligent systems can now incorporate the context of the event and the ability to respond all in one, contextual, and highly-informative view. This is a big satisfier for caregivers as they not only have been notified of the event, but they also have both the context around the event and the ability to easily respond to it by intuitively communicating, through either voice or text, inside the context of the event.
While the concept of event response is not novel, the technologies enabling it to be used effectively in healthcare is new and very exciting.
An important component of patient safety
By turning down the background noise, and helping clinicians prioritize the most crucial alarms, hospitals can simplify and streamline care team workflows, drawing clinicians’ attention only to the most important alerts, at the right time. A modern approach to alarm management combines and prioritizes disparate communication across channels and vendors. Safety and quality teams at hospitals are rightly concerned about the impact of limited memory in the “human hard drive” and how that slows down processing speeds and minimizes performance. By closing some programs running in the background, i.e. eliminating some unnecessary notifications and alarms, hospitals can free up clinicians’ mental capacity and increase the valuable time they can spend addressing patients who can benefit most from immediate attention.