Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms

• Published in: PloS one Vol. 13; no. 5; p. e0197157
• Main Authors: McFarlane, Daniel C, Doig, Alexa K, Agutter, James A, Brewer, Lara M, Syroid, Noah D, Mittu, Ranjeev
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.05.2018; Public Library of Science (PLoS)
• Subjects: Alarm systems; Alarms; Analysis; Anesthesiology; Biology and Life Sciences; Communication; Control; Design; Drug administration; Engineering and Technology; Health care; Health care costs; Health care policy; Hospitals; Intensive care; Medical care; Medical errors; Medical personnel; Medicine and Health Sciences; Metacognition; Nurses; Nursing care; Occupational safety; Patient safety; Patients; People and Places; Research and Analysis Methods; Response time; Safety; Safety and security measures; Service introduction; Software; Studies; Supervision; Surveillance; Wearable technology; Workloads; United States > US; Utah
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0197157

This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.