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Sounding the alarm...About too many alarms.

By Rob Lewis

Medical errors are the third leading cause of death in the United States. According to a recent study published in the British medical Journal, the mean rate of death from medical errors is 251,454. See http://www.bmj.com/content/353/bmj.i2139.

Medical errors can occur at the individual level (i.e. an error by an individual nurse or doctor) or at the systemic level (i.e. failures in the hospital or healthcare system that enables an error to occur). Examples of systemic errors include poor training and negligent credentialing where a hospital or healthcare system brings on employees or medical staff that are not appropriately qualified and fails to teach or train them how to safely care for patients. Other examples of systemic-type errors include insufficient facilities or bad equipment in which a hospital or healthcare system provides defective tools, instruments or equipment or fails to maintain the tools, instruments or equipment so that they are safe for patient use. Systemic errors are particularly concerning because they are prone to be repeated across the patient population and have the potential to harm greater numbers of people. Systemic errors are also concerning because they may lead more than one provider (doctor, nurse, aide or tech) to commit errors that otherwise they would not have committed.

A recent article in the Washington Post brought to light one type of systemic error that has the potential to cause great harm: the tendency of healthcare providers to disable, ignore or override alarms. See https://www.washingtonpost.com/national/health-science/doctors-are-overloaded-with-electronic-alerts-and-thats-bad-for-patients/2016/06/10/0cae6b4a-20fa-11e6-9e7f-57890b612299_story.html

The problem is called "alert fatigue", and it has been compounded by the extensive number of alerts and pop-up built into electronic health records, a fairly recent development in healthcare. According to the author, these alerts are quite similar to those that pop-up on your phone reminding you of deadlines, meetings and birthdays. When there are too many, you get overwhelmed and they turn into noise.

In the context of healthcare, however, the results of ignoring pop-ups could be deadly for example in the case of a warning concerning potential harmful effects of a medication. The article, while addressing the problem, did not end on a very positive note in terms of identifying solutions: Makers of electronic medical records are working on more targeted and relevant alerts but in the meantime hospitals that have money and manpower are left to their own devices to decide what merits a warning or alert. Ultimately, though it is the provider's and the hospital's responsibility to make sure that warnings are being headed and patients are being safely monitored.

In our office, we see cases all of the time where clear warnings of infection, illness, and pot-operative complications are overlooked, and the thought that the alerts and warnings that are suppose to prevent these problems are actually contributing to them and making them worse is particularly worrisome. Also concerning is the fact that there are no clear answers to the problem of "alert fatigue." Clearly, this is a case where a systemic problem is endangering patients. Likewise, it will require a systemic fix: better records, better software, more targeted alarms, and better training of health care providers in terms of what is critical and what is not. This is, in large part, a hospital responsibility. Whether hospitals will step up with the manpower and money required to fix the problem is another story.

In the meantime, take care of yourself. If your own health is at stake, make sure you ask questions.

Why is that light blinking?

What is that alarm sounding for?

Why are those numbers in red?

Should I be worried about that buzzer?

Do not be afraid to make your doctor or nurse aware of alarms, buzzers or warnings that you see. Do not be afraid to hit the nurse call button or to call the doctor if you see an alert. Do not be afraid to ask questions. If you are going to be sedated or incapacitated, be sure to bring a family member or friend to advocate for you. Be aware of "alert fatigue" and do not assume your doctors and nurses are hearing, seeing and paying attention to the same things that you are.

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