The DOI matches its Crossref record; 50 of the 52 references it cites were found in a registry or an index.
Alarm system management: evidence-based guidance encouraging direct measurement of informativeness to improve alarm response
Abstract
Although there are powerful incentives for creating alarm management programmes to reduce ‘alarm fatigue’, they do not provide guidance on how to reduce the likelihood that clinicians will disregard critical alarms. The literature cites numerous phenomena that contribute to alarm fatigue, although many of these, including total rate of alarms, are not supported in the literature as factors that directly impact alarm response. The contributor that is most frequently associated with alarm response is informativeness, which is defined as the proportion of total alarms that successfully conveys a specific event, and the extent to which it is a hazard. Informativeness is low across all healthcare applications, consistently ranging from 1% to 20%. Because of its likelihood and strong evidential support, informativeness should be evaluated before other contributors are considered. Methods for measuring informativeness and alarm response are discussed. Design directions for potential interventions, as well as design alternatives to traditional alarms, are also discussed. With the increased attention and investment in alarm system management that alarm interventions are currently receiving, initiatives that focus on informativeness and the other evidence-based measures identified will allow us to more effectively, efficiently and reliably redirect clinician attention, ultimately improving alarm response.
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Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Our findings suggest that responses to textual alerts in EHRs are similar to previously documented responses to audible and visual alarms. [16–18]”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [16]
In the citing paper
“it is well-established in the human factors literature that false alarms reduce responsiveness to alarms and may also reduce overall performance on tasks interrupted by alarms. [16–18]”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [16]
In the citing paper
“Uninformative alerts are similar to false alarms”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [16]
In the citing paper
“The human factors literature in other settings shows that high false alarm rates reduce responsiveness as the individual learns, consciously or unconsciously, that the alarm is unreliable [16–18].”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [16]
In the citing paper
“In other settings, low alarm informativeness and increased cognitive workload predict poor alarm response.”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [16]
Citations
Cites
Multiple Resources and Mental Workload
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Joint Commission on Accreditation of Healthcare Organizations
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Mental workload while driving: effects on visual search, discrimination, and decision making.
Recarte, M. A., & Nunes, L. (2003) · Journal of experimental psychology. Applied · doi:10.1037/1076-898x.9.2.119 · Cited by 757
Monitor Alarm Fatigue : An Integrative Review
Cvach, M. M. (2012) · Biomedical Instrumentation & Technology · doi:10.2345/0899-8205-46.4.268 · Cited by 641
The Field Guide to Understanding Human Error
Dekker, S. W. A. (2017) · CRC Press eBooks · doi:10.1201/9781315239675 · Cited by 538
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The benefits of imperfect diagnostic automation: a synthesis of the literature
Wickens, C. D., & Dixon, S. R. (2007) · Theoretical Issues in Ergonomics Science · doi:10.1080/14639220500370105 · Cited by 423
Human probability matching behaviour in response to alarms of varying reliability
Bliss, J. P., Gilson, R. D., & Deaton, J. E. (1995) · Ergonomics · doi:10.1080/00140139508925269 · Cited by 297
The alarm problem and directed attention in dynamic fault management
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Cited by
Sorted by citations
with the HITEC Investigators, Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-017-0430-8 · Cited by 709
“Response rates may reflect probability matching, a cognitive phenomenon in which likelihood of acting in response to a stimulus becomes calibrated to pay-off likelihood [16, 36].”
BackgroundChen, L., Dubrawski, A. W., Wang, D., Fiterau, M., Guillame-Bert, M., Bose, E. L., Kaynar, A. M., Wallace, D. J., Guttendorf, J., Clermont, G., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001660 · Cited by 76
Ruppel, H., Vaux, L. D., Cooper, D. A., Kunz, S., Duller, B., & Funk, M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0205901 · Cited by 54
Surveillance Monitoring Management for General Care Units: Strategy, Design, and Implementation
McGrath, S. P., Taenzer, A. H., Karon, N. M., & Blike, G. T. (2016) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(16)42040-4 · Cited by 53
Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units
Ruppel, H., Funk, M., & Whittemore, R. (2018) · American Journal of Critical Care · doi:10.4037/ajcc2018385 · Cited by 49
Metadata
- Authors
- Rayo, M. F., & Moffatt-Bruce, S. D.
- Affiliations
- The Ohio State University (US)
- Corresponding author
- Rayo, Michael F
- ORCID
- Rayo, Michael F
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2015-03-02
- Volume
- 24
- Issue
- 4
- Pages
- 282-286
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- OpenAlex
- W2096457720
- Cited by
- 115
- References
- 52
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 5 · 2023: 17 · 2022: 6 · 2021: 10 · 2020: 16 · 2019: 11 · 2018: 13 · 2017: 9 · 2016: 10 · 2015: 3
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- alarm fatigue, alarm system, alarm response, alarm system design, patient safety
- MeSH terms
- Attention, Attitude of Health Personnel, Equipment Failure, Humans, Monitoring, Physiologic, Nursing Staff, Hospital, Reaction Time, Workload, Safety Management, Clinical Alarms
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