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SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit

Journal of Clinical Monitoring and Computing volume 34, pages 787–796 (2020)Cite this article

Abstract

Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials—two multisensory (auditory and tactile) and two unisensory (auditory). Analysis compared the unisensory trials to the multisensory trials based on the percentage of correctly identified point of change, direction of change and identity of three physiological parameters (indicated by different instruments): heart rate (drums), blood pressure (piano), blood oxygenation (guitar). A repeated-measures of ANOVA yielded a significant improvement in performance for the multisensory group compared to the unisensory group (p < 0.05). Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.

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References

  1. Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. 2013;24(4):378–86.

    Article  PubMed  Google Scholar 

  2. Couch C. How redesigning the abrasive alarms of hospital soundscapes can save lives.

  3. Kit S. ECRI’s Top 10 Health Technology Hazards for 2013. Health Devices. 2013;41(11):342–65.

    Google Scholar 

  4. Casey S, Avalos G, Dowling M. Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: a multicentre study. Intensive Crit Care Nurs. 2018;48:36–41.

    Article  PubMed  Google Scholar 

  5. Kristensen MS, Edworthy J, Özcan Vieira E, Denham S. Alarm fatigue in the perception of medical soundscapes. In: European congress and exposition on noise control engineering, 2015, pp. 745–50.

  6. Lacherez P, Limin Seah E, Sanderson P. Overlapping melodic alarms are almost indiscriminable. Hum Factors. 2007;49(4):637–45. https://doi.org/10.1518/001872007x215719.

    Article  PubMed  Google Scholar 

  7. Purbaugh T. Alarm fatigue: a roadmap for mitigating the cacophony of beeps. Dimens Crit Care Nurs. 2014;33(1):4–7.

    Article  PubMed  Google Scholar 

  8. Cropp AJ, Woods LA, Raney D, Bredle DL. Name that tone: the proliferation of alarms in the intensive care unit. Chest. 1994;105(4):1217–20.

    Article  CAS  PubMed  Google Scholar 

  9. Hasanain B, Boyd AD, Bolton ML. Using model checking to detect simultaneous masking in medical alarms. IEEE Trans Hum–Mach Syst. 2016;46(2):174–85.

    Article  Google Scholar 

  10. Kramer G, et al. Sonification report: status of the field and research agenda. Lincoln: University of Nebraska; 2010.

    Google Scholar 

  11. Janata P, Childs E. Marketbuzz: sonification of real-time financial data. Georgia Institute of Technology; 2004.

  12. Barrass S, Kramer G. Using sonification. Multimed Syst. 1999;7(1):23–31.

    Article  Google Scholar 

  13. Harrison WJ, Thompson MB, Sanderson PM. Multisensory integration with a head-mounted display: background visual motion and sound motion. Hum Factors. 2010;52(1):78–91. https://doi.org/10.1177/0018720810367790.

    Article  PubMed  Google Scholar 

  14. Fitch WT, Kramer G. Sonifying the body electric: superiority of an auditory over a visual display in a complex, multivariate system. In: Santa FE Institute Studies in the Sciences of Complexity—proceedings volume, vol. 18. Boston: Addison-Wesley Publishing Co; 1994, p. 307.

  15. Hermann T. Taxonomy and definitions for sonification and auditory display. In: Proceedings of the 14th international conference on auditory display (ICAD 2008), 2008.

  16. Ballora M, Pennycook B, Ivanov PC, Glass L, Goldberger AL. Heart rate sonification: a new approach to medical diagnosis. Leonardo. 2004;37(1):41–6.

    Article  Google Scholar 

  17. Wang J. Emergency healthcare workflow modeling and timeliness analysis. IEEE Trans Syst Man Cybern A. 2012;42(6):1323–31.

    Article  Google Scholar 

  18. Kang Y, Li Z, Zhao Y, Qin J, Song W. A novel location strategy for minimizing monitors in vehicle emission remote sensing system. IEEE Trans Syst Man Cybern Syst. 2018;48(4):500–10.

    Article  Google Scholar 

  19. Nunes VT, Werner CML, Santoro FM. Dynamic process adaptation: a context-aware approach. IEEE; 2011, pp. 97–104.

  20. Ziat M, Wagner S, Frissen I. Haptic feedback to compensate for the absence of horizon cues during landing. In: International conference on human haptic sensing and touch enabled computer applications. Springer; 2016, pp. 47–54.

  21. Watson M, Sanderson P. Sonification supports eyes-free respiratory monitoring and task time-sharing. Hum Factors. 2004;46(3):497–517. https://doi.org/10.1518/hfes.46.3.497.50401.

    Article  PubMed  Google Scholar 

  22. Aaltonen I, Laarni J. Field evaluation of a wearable multimodal soldier navigation system. Appl Ergon. 2017;63:79–90.

    Article  PubMed  Google Scholar 

  23. Sanderson PM, et al. Monitoring vital signs with time-compressed speech. J Exp Psychol Appl. 2019. https://doi.org/10.1037/xap0000217.

    Article  PubMed  Google Scholar 

  24. Edworthy J, et al. The recognizability and localizability of auditory alarms: setting global medical device standards. Hum Factors. 2017;59(7):1108–27. https://doi.org/10.1177/0018720817712004.

    Article  PubMed  Google Scholar 

  25. Li SYW, Tse M-K, Brecknell B, Sanderson PM. Spearcon sequences for monitoring multiple patients: laboratory investigation comparing two auditory display designs. Hum Factors. 2018;61(2):288–304. https://doi.org/10.1177/0018720818797502.

    Article  PubMed  Google Scholar 

  26. Deb S, Claudio D. Alarm fatigue and its influence on staff performance. IIE Trans Healthc Syst Eng. 2015;5(3):183–96.

    Article  Google Scholar 

  27. Torabizadeh C, Yousefinya A, Zand F, Rakhshan M, Fararooei M. A nurses’ alarm fatigue questionnaire: development and psychometric properties. J Clin Monit Comput. 2017;31(6):1305–12.

    Article  PubMed  Google Scholar 

  28. Petersen EM, Costanzo CL. Assessment of clinical alarms influencing nurses’ perceptions of alarm fatigue. Dimens Crit Care Nurs. 2017;36(1):36–44.

    Article  PubMed  Google Scholar 

  29. McCambridge J, De Bruin M, Witton J. The effects of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS ONE. 2012;7(6):e39116.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Lee Y-C, Lee JD, Ng Boyle L. Visual attention in driving: the effects of cognitive load and visual disruption. Hum Factors. 2007;49(4):721–33.

    Article  PubMed  Google Scholar 

  31. Ho C, Tan HZ, Spence C. Using spatial vibrotactile cues to direct visual attention in driving scenes. Transp Res F. 2005;8(6):397–412.

    Article  Google Scholar 

  32. Wolpert RS. Recognition of melody, harmonic accompaniment, and instrumentation: musicians vs. nonmusicians. Music Percept Interdiscip J. 1990;8(1):95–105.

    Article  Google Scholar 

  33. Schellenberg EG, Habashi P. Remembering the melody and timbre, forgetting the key and tempo. Mem Cogn. 2015;43(7):1021–31.

    Article  Google Scholar 

  34. Siedenburg K, McAdams S. Short-term recognition of timbre sequences: music training, pitch variability, and timbral similarity. Music Percept Interdiscip J. 2018;36(1):24–39.

    Article  Google Scholar 

  35. Bogers K. Care Tunes: music as a nurses’ monitoring tool. https://delftdesignlabs.org/criticalalarmslab/. Accessed Nov 2018.

  36. Janata P, Edwards WH. A novel sonification strategy for auditory display of heart rate and oxygen saturation changes in clinical settings. Hum Factors. 2013;55(2):356–72. https://doi.org/10.1177/0018720812455433.

    Article  PubMed  Google Scholar 

  37. Lofelt. Basslet haptic actuator. https://eu.lofelt.com/. Accessed 30 June 2018.

  38. Paterson E, Sanderson P, Paterson N, Loeb RG. Effectiveness of enhanced pulse oximetry sonifications for conveying oxygen saturation ranges: a laboratory comparison of five auditory displays. Br J Anaesth. 2017;119(6):1224–30.

    Article  CAS  PubMed  Google Scholar 

  39. Alirezaee P, Girgis R, Kim T, Schlesinger JJ, Cooperstock JR. Did you Feel that? Developing novel multimodal alarms for high consequence clinical environments. Georgia Institute of Technology; 2017.

  40. Burdick K, Courtney M, Wallace MT, Baum Miller SH, Schlesinger JJ. Living and working in a multisensory world: from basic neuroscience to the hospital. Multimodal Technol Interact. 2019;3(1):2.

    Article  Google Scholar 

  41. Eagle DM, Baunez C, Hutcheson DM, Lehmann O, Shah AP, Robbins TW. Stop-signal reaction-time task performance: role of prefrontal cortex and subthalamic nucleus. Cereb Cortex. 2007;18(1):178–88.

    Article  PubMed  Google Scholar 

  42. Verbruggen F, Logan GD. Response inhibition in the stop-signal paradigm. Trends Cogn Sci. 2008;12(11):418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Verbruggen F, Logan GD. Models of response inhibition in the stop-signal and stop-change paradigms. Neurosci Biobehav Rev. 2009;33(5):647–61.

    Article  PubMed  Google Scholar 

  44. Eva KW, Link CL, Lutfey KE, McKinlay JB. Swapping horses midstream: factors related to physicians’ changing their minds about a diagnosis. Acad Med J Assoc Am Med Coll. 2010;85(7):1112.

    Article  Google Scholar 

  45. Royall DR, et al. Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 2002;14(4):377–405.

    Article  PubMed  Google Scholar 

  46. Verbruggen F, Logan GD, Stevens MA. STOP-IT: windows executable software for the stop-signal paradigm. Behav Res Methods. 2008;40(2):479–83.

    Article  PubMed  Google Scholar 

  47. Mauchly JW. Significance test for sphericity of a normal n-variate distribution. Ann Math Stat. 1940;11(2):204–9.

    Article  Google Scholar 

  48. Ross LA, Saint-Amour D, Leavitt VM, Javitt DC, Foxe JJ. Do you see what I am saying? Exploring visual enhancement of speech comprehension in noisy environments. Cereb Cortex. 2006;17(5):1147–53.

    Article  PubMed  Google Scholar 

  49. Blum JR, Frissen I, Cooperstock JR. Improving haptic feedback on wearable devices through accelerometer measurements. In: Proceedings of the 28th annual ACM symposium on user interface software and technology. ACM; 2015, pp. 31–6.

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Acknowledgements

Non-clinical time support came from the Vanderbilt Department of Anesthesiology. We would like to thank Dr. Matthew Walker III, Dr. Matthew Weinger, Dr. Pratik Pandharipande, Dr. Jeff Blum, and Dr. Antoine Weill-Duflos for their support and advice throughout this project. We would also like to thank Vanderbilt Medical Center’s Department of Anesthesiology and Vanderbilt School of Engineering. We also received support through the provision of physiological parameter sounds from Koen Bogers, MS and Design United (The Netherlands). Finally, thank you to Jesse Li, Abigail Bell, and Alice Li for their assistance in running study participants.

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Authors and Affiliations

  1. University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA

    Kendall J. Burdick

  2. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA

    Seiver K. Jorgensen, Taylor N. Combs, Megan O. Holmberg & Samantha P. Kultgen

  3. Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA

    Joseph J. Schlesinger

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  1. Kendall J. Burdick
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  2. Seiver K. Jorgensen
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Correspondence to Kendall J. Burdick.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee [Vanderbilt University Medical Center Institutional Review Board (ID 170485)] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Burdick, K.J., Jorgensen, S.K., Combs, T.N. et al. SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit. J Clin Monit Comput 34, 787–796 (2020). https://doi.org/10.1007/s10877-019-00381-1

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  • DOI: https://doi.org/10.1007/s10877-019-00381-1

Keywords

  • Alarm fatigue
  • Medical errors/prevention
  • Multisensory
  • Noise/adverse effects
  • Vibrotactile display