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Intensive care units (ICUs) and operating theaters are equipped with medical devices that monitor patients and inform or warn clinicians with regards to the patient’s vital health status and its criticality. In return, clinicians are expected to follow a procedure or act upon the critical event. For this information exchange, clinicians rely heavily on auditory alerts to pinpoint an emerging problem in the patient’s vitals. These alerts and the monitoring devices are the essential parts of an auditory display which can be designed to evoke the most effective response in the clinicians.

However, the current practices in the ICUs and operating theaters indicate that auditory display design is far from optimal. Nurses suffer from the multiplicity of these auditory alerts and the often false urgency they evoke. They also find that the alerts are difficult to discriminate, too loud, too urging, and not informative. Thus is also a phenomenon called ‘alarm fatigue. Patients also suffer from delirium caused by a noisy environment (constant monitoring and alerting) which prevent them from sleeping and thus recovering. What is more, the visitors are worried and anxious to help but hearing the alerts of which they cannot make sense worsens their emotional status and judgment capabilities. Furthermore, there is no consensus among the medical device manufacturers as to how to interpret the ISO standards for alarms. Each brand use their own set of sounds, consequently two devices from different brands with the same functionality emit two totally different sounds. Thus, the soundscape in the ICUs and operating theaters can be disorderly and chaotic. In the event of switching devices or workplaces, nurses are forced to unlearn the old sound and learn the new ones.

Possible questions:

  • How can design help to improve the clinicians work experience (nursing staff and doctors), patients’ recovery process and visitors short stay? Any good design ideas you want to share?
  • What positions do medical device manufacturers take to deal with the aforementioend current issues? Do they apply alarm management?
  • What is the state of the art auditory display design solutions and can we learn from good practices in other fields?
  • What is the contribution of other modalities (visual or haptic warnings / information) to auditory display design?
  • What sound design principles should be applied to optimise the response of the nurses?

Student Articles

A framework for unisensory and multisensory design for hospital alarming systems.

By: C.R.G. Cuijpers

This paper will state a framework for unisensory and multisensory design for alarming hospital systems. The paper will start with a brief introduction on the common situations in hospitals and the possible value of using tactile, visual or multisensory cues. Further on the real value of these sensors will be reviewed. First I will talk about the effect that vibrotactile sensors have on the response time of a person. To add an extra dimension I will also review multisensory researches including audiovisual sensors that can attract spatial attention in dual-task performance and audio-tactile sensors that can provide an even faster response time if both sensors come from the same direction. These findings will be abstracted and put in the hospital context as an inspiration for future designers. As a conclusion I will provide a framework for designers to have a quick look at the biggest findings in the previously mentioned research that is done in the field of unisensory and multisensory design for alarming systems.

Cleaning up the hospital soundscape: How to reduce ambient noise to prevent stress and fatigue?

By: D.Jolles

A lot of sounds can be heard in a hospital environment. Not all these sounds are relevant to all the people that can hear them. In other words: the hospital soundscape contains a lot of ambient noise.This paper is about understanding this ambient noise in a hospital on both a perceptional and physical level. Relevant factors and details are provided on the perception of this soundscape. A study has been conducted in which papers are reviewed that are about sounds in the hospital and the effects on staff and patients. With the results of this study suggestions are made how to improve the way sounds are distributed to participants (patients and staff) of the hospital environment. These suggestions will be also reviewed from both a staff and patient perspective.

The Multifaceted Solution for Alarm Fatigue

By: N. Lugtenburg

Technological innovations have transformed hospitals in an environment where a plethora of devices make sounds. Research has demonstrated that up to 99% of these alarms require no clinical intervention. The excessive amount of irrelevant alarms has led to alarm fatigue, which occurs when clinicians are overwhelmed by the number of alarms and as a result become desensitized to them. This has already resulted in several patient deaths. Strategies focused on reducing irrelevant alarms, such as individualizing alarm settings, have proved significant reductions in the amount of alarms, but to overcome the problem all stakeholders must work together and a wider perspective to alarm (system) issues is needed. Solutions must be designed with a focus on the user and its needs and capabilities. Standardizing and redesigning current alarms into meaningful sounds could make a real difference. However, integrated and intelligent notification systems like Ascom Myco seem the most promising long-term solution for eliminating alarm fatigue and will create a more efficient, less-stressful and safer healthcare environment.

Auditory design for the Intensive Care Unit (ICU): Guidelines and considerations.

By: G. Meza Perez

This paper discusses the current state of auditory elements in the ICU and their effect in patients and medical staff. It presents a set of guidelines and observations that aim for a better alarm implementation and outcome based on user research with generic alarm sounds. Through metaphors, codification and categorization alarms can indicate urgency level and action required from the staff. The redesign of those auditory icons can also help the wellbeing of patients during their stay in the ICU.


Urgency mapping in auditory alarms: designing for the noisy ICU

By: L.E. Smit

Noise pollution in the ICU is a big problem with alarm fatigue as a consequence. Alarm management is needed, not only should there be less alarms, but also the acoustic quality of the alarms is of essence. Urgency mapping in alarms could prove a fruitful solution. In this paper different auditory alarm solutions which are susceptible to urgency mapping are discussed.

Safe and Sound: A plea for considering context related factors for the intended urgency of alarms

By: M. Verbeij

This report contains the setup, execution and results of a research toward the influence of context on perceived urgency in auditory alarms. It utilizes a user-centered approach to determine appropriate levels for four acoustical properties (pitch, pitch range, between signal interval and between pulse interval) in several working and living situations. The research is meant to inform alarm designers on the importance of context in their work and to provide them with a suggestion of values for the four acoustical properties named above.