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.

Differences across clinician type and levels of clinical training were found in both measures during patient handovers. The findings suggest that training could enable physicians and nurses to learn communication competencies during patient handovers which were used more frequently by more experienced practitioners, including interjecting less frequently and using interactive questioning strategies to clarify understanding, and assertively question the appropriateness of diagnoses, treatment plans and prognoses. Accompanying cultural change initiatives might be required to routinely employ these strategies in the clinical setting, particularly for nursing personnel.

The reserved set of audible alarm signals embodied within the global medical device safety standard, IEC 60601-1-8, is known to be problematic and in need of updating. The current alarm signals are not only suboptimal, but there is also little evidence beyond learnability (which is known to be poor) that demonstrates their performance in realistic and representative clinical environments. In this article, we describe the process of first designing and then testing potential replacement audible alarm signals for IEC 60601-1-8, starting with the design of several sets of candidate sounds and initial tests on learnability and localizability, followed by testing in simulated clinical environments. We demonstrate that in all tests, the alarm signals selected for further development significantly outperform the current alarm signals. We describe the process of collecting considerably more data on the performance of the new sounds than exists for the current sounds, which ultimately will be of use to end users. We also reflect on the process and practice of working with the relevant committees and other practical issues beyond the science, which also need constant attention if the alarms we have developed are to be included successfully in an updated version of the standard.

As we design automated and autonomous products that make increasingly sophisticated inferences and stronger interjections in a wider range of settings, it is increasingly critical to conceptualize these products as cognitive agents, and not simply as passive tools. Our repertoire of heuristics and techniques must expand to explicitly support not only a person’s ability to take actions, but also to make sense of the world, determine the applicability of current and future plans, and select appropriate actions among many alternatives. These machine agents will also be expected to perform some or all of these functions themselves. Collectively, these attributes can be thought of as facilitating collaborative autonomy, in which all agents in the system can express initiative and cede authority based on their understanding of the world. However, product design is not the first discipline to face these problems or design these types of solutions. Cognitive Systems Engineering has been integrating and adding to the knowledge base in these areas for over 30 years. With some effort in translating their findings to our projects, we will be able to accelerate innovation and avoid the pitfalls and unintended consequences of previous attempts at increasing inference and interjection.

We assess the relationship of active or passive presentation of Best Practice Advisories (BPAs) for hospital clinicians with compliance rates of recommended actions. We identify the design characteristics of alerts that can be used to assess the effectiveness of design choices with superior usability. Alerts in Electronic Health Records (EHRs) are frequently overridden by healthcare providers. Identifying characteristics of effective alerts can increase the frequency that actions recommended in evidence-based care guidelines are done, reduce user frustration, and improve interface usability along with the willingness to use alerts. We conducted a retrospective analysis of data for 11 BPAs between June 2014 and May 2015. The outcome measure was the percent correspondence with recommended actions. A repeated measures regression model was used for the correlation of the BPA presentation type with the outcome measure. The BPA presentation type was significant such that the odds are 7.7 times greater that a recommended action would be taken by a provider with an active BPA presentation type after adjusting for whether an action was required. Active presentation alerts achieve higher compliance rates. CDS alerts that actively interrupted the provider’s workflow were associated with a higher compliance rate with recommended actions.