By Mimi Zander
During my undergraduate studies at Rutgers University, I studied English, women’s and gender studies, and literary theory. As part of The Institute for Women’s Leadership Scholars Program, during class discussions, we would circle back to the idea of bridging theory and practice. The first step is identifying the problem. The next step is to discuss, research, and theorize about the problem. Finally, we need to leave our safe academic bubble and enact the solutions that we colorfully described to each other and our professors. I am finding this framework to be enormously helpful in unpacking the work I am doing at The Children’s Hospital of Philadelphia (CHOP) as part of the Society of Hospital Medicine’s Student Scholars program.
My work at CHOP tackles step one and two in a scientifically rigorous way: identify alarm fatigue in our hospital and determine how it occurs on our floors. What I find deeply satisfying about this work is that the scope is relatively small but the impact is potentially huge. Our results will directly impact step three, turning theory into practice. The solution is simple, reduce alarms — but what would that actually sound like on the floor?
My main role this summer is to review hundreds of hours of patient care videos in order to determine whether alarms are valid (reflect the patient’s physiologic status) and actionable (a clinician intervenes or changes the patient’s care in some way). This task forces me to listen to the patient’s room for six hour stretches. There’s chirping and buzzing from monitors and pumps, quick and slow footsteps of nurses, patients, and visitors, wheels scraping the floor, staff calling out to each other — the familiar sounds of any hospital. During my video reviews, I think about how I would remodel the sounds of the floor.
Here is what I have come up with so far:
The first improvement I would make is to filter out all non-actionable physiologic monitor alarms, or alarms that do not require an intervention (note: while this is easy to discuss as a thought experiment, it is tremendously challenging in practice). According to our pilot study, this would instantly remove 99% of the noise from the monitor on a general pediatrics floor.
Next, I would do something about IV pump alarms. After silencing the non-urgent alarms, I would change the sound effects of the alarms that are left to something less grating, perhaps even musical. These two changes should cut down on most of the noise and allow only the most critically important alarms to break through the quiet. When an alarm goes off in this remodeled alarm system, any clinician within earshot would be encouraged to respond since the chances of that alarm being important would be very high.
Our study lays the groundwork to improve our monitoring systems to decrease alarm fatigue experienced by our nurses. This has implications for patient safety, general nurse fatigue, and the quality of patients’ stays. This important work is developing the theories that will immediately affect practice in a tangible way. Hopefully, after the publication and dissemination of this work, hospitals around the country will reimagine how their floors will sound and make the necessary adjustments to lower the volume of each patient’s room, one alarm at a time.
Mimi Zander is a rising second year student at the Touro College of Osteopathic Medicine in Harlem, New York City. She is one of three medical students to receive SHM’s Student Hospitalist Scholar Grant with which she is completing scholarly work related to patient safety in the hospital. Mimi received her B.A. from Rutgers University in 2011 with a concentration in English, and she completed her post baccalaureate studies at the University of Pennsylvania.