BackgroundClinicians in intensive care units experience alarm fatigue related to frequent false and non-actionable alarms produced by physiologic monitors. To reduce non-actionable alarms, alarm settings may need to be customized for individual patients; however, nurses may not customize alarms because of competing demands and alarm fatigue.ObjectiveTo examine the effectiveness and acceptance of physiologic monitor software to support customization of alarms.MethodsThis pre/post intervention study was conducted in a 56-bed medical intensive care unit. IntelliVue® Alarm Advisor customization support software for alarm limit violations was installed on all monitors and education on its use provided. For 2 months before and after implementation of the software, data were collected on patient characteristics from the electronic health record, alarm counts and duration from the monitoring system, and nurses’ experience of alarms from a survey.ResultsMedium-priority heart rate, respiratory rate, and arterial pressure alarms were significantly reduced after software implementation (9.3%, 11.8%, and 15.9% reduction respectively; p<0.001 for all). The duration of these alarms was also significantly shorter (7.8%, 13.3%, and 9.3% reduction respectively; p<0.05 for all). The number and duration of SpO2 alarms did not decrease (p>0.05 for both). Patients post-intervention had worse Glasgow Coma Scale scores (p = 0.014), but otherwise were comparable to those pre-intervention. Nurses reported less time spent on non-actionable alarms post-intervention than pre-intervention (p = 0.026). Also lower post-intervention were the proportions of nurses who reported that alarms disturbed their workflow (p = 0.027) and who encountered a situation where an important alarm was ignored (p = 0.043). The majority (>50%) agreed that the software supported setting appropriate alarm limits and was easy to use.ConclusionAlarm customization software was associated with a reduction in alarms. Use of software to support nurses’ recognition of trends in patients’ alarms and facilitate changes to alarm settings may add value to alarm reduction initiatives.
As the Internet is increasingly absorbing information from the real world it becomes more important to prevent unauthorized collection and abuse of personalized information. At the same time, democratic societies should establish an environment helping not only their own people but also people who face repressive censorship to access public information without being identified or traced. Internet anonymization tools such as Tor offer functionalities to meet this demand.In practice, anonymization of Internet access can only be achieved by accepting higher latency, i.e., a longer waiting time before a Web site is displayed in the browser, and therefore reducing its usability significantly. Since many users may not be willing to accept this loss of usability, they may refrain from or stop using Tor -at the same time decreasing the anonymity of other users, which depends on shared resources in the Tor user community. In this paper 1 , we quantify the loss of usability by measuring the additional latency of the Tor software and combine our measurements with metrics of the existing Web usability and performance literature. Our findings indicate that there is still a major usability gap induced by Tor, leading to its possible disuse accompanied by a higher risk exposure of Internet users.
Abstract. Complex Event Processing -the identification of event patterns in event streams, the analysis of their impact, and the execution of corresponding actions -is gaining momentum within various research disciplines and business areas. However, one of the major problems associated with Complex Event Processing is its lack of usability, especially the complexity of its management, preventing its wide diffusion and adoption by users. This usability issue is addressed in this paper by applying Business Process Modeling Notation as graphical support for the definition of complex event patterns.
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