The idea of a “quiet” intensive care unit (ICU) may seem like a far-fetched dream to clinicians, patients, and caregivers, but with the help of artificial intelligence (AI), this vision is becoming a reality.

In a traditional ICU, patients are surrounded by constant noise and commotion. Beeping machines, alarms, and the hustle and bustle of doctors and nurses can make it difficult for patients to rest and recover. This constant noise can also be stressful and overwhelming for family members visiting their loved ones in the ICU.

We’ve all become accustomed to the cacophony of noise that invades our mental space whenever we step foot into a hospital setting. I’ve spent a decent amount of time in ICUs throughout my career, and though I’ve never quite gotten used to the chaotic alarms, I have developed the ability to tune most of them out. This propensity to ignore the omnipresent stream of alarms in hospitals relies on the knowledge that I’m surrounded by capable clinicians who will likely address the alarm if it warrants. 

It’s taken some time to get comfortable with trusting the status quo. But alarms are still sounding even though I may not be listening. And I’m now just beginning to appreciate that the individuals who do have to listen (nurses, doctors, other clinicians) are also learning to “block out” certain alarms because the majority of them are false! If erroneous noise is a mental barrier that all of us, including patients and caregivers, must overcome when stepping into an ICU, then why do we need these alarms in the first place? It’s a fair question that we’ll address in a follow-up post. But in this article, I want us to envision the future of healthcare. A future where equipment and data are fully connected. Where units are fully staffed. And where monitors only beep when there is direct action required to improve patient care.

 

A quiet ICU is possible, and there are many benefits to this peace and calm.

 

These benefits reach hospitals, clinicians, patients, and their families:

For hospitals, a quiet ICU can improve the overall patient experience. This increases patient satisfaction rates, which in turn can lead to positive word-of-mouth and improved hospital reputation.  Higher reimbursements tied to improved patient satisfaction scores directly hit the bottom line.  A quiet ICU can also reduce the risk of medical errors, as a calm and serene environment can decrease the medical staff’s cognitive load, empowering them to work more efficiently.

For clinicians, a quiet ICU can help reduce burnout and improve job satisfaction. Working in a noisy and chaotic environment is stressful and exhausting for medical staff. A quieter ICU provides a more pleasant and conducive work environment, leading to better job satisfaction and a reduced risk of burnout. This ER physician speaks to the importance of minimizing interruptions due to alerts and alarms so that he can optimize care.

For patients, a quiet ICU can provide numerous benefits. Sleep is a major one. Ongoing studies are showing that improved sleep leads to improved recovery for patients. Rest is the obvious one.  A peaceful and serene environment helps patients rest and recover more effectively. It can also reduce stress and anxiety, which can positively impact the patient’s overall health and well-being.  

For patients’ families, a quiet ICU can provide a more comfortable and supportive environment for visiting their loved ones. It can also make it easier for families to communicate with medical staff and understand the patient’s condition, which can provide much-needed peace of mind during a difficult time.

 

Some progress has already been made towards a quiet ICU.

 

Clinical pioneers such as Maria Cvach (Johns Hopkins) have shown that a 50% reduction in ICU noise is possible simply by adjusting monitor alarm default settings. This noise reduction greatly impacts nurse perception, for 97% of the nurses surveyed recognized a noticeable decrease in ICU noise after alarm settings were adjusted. 

Furthermore, a group of Dutch clinicians confirmed Cvach’s findings that adaptive vital signs alarm thresholds–ones that take into account personal and situational factors rather than just one-size-fits-all factory settings–may “improve early detection of adverse events and reduce alarm rates.”

 

Patient physiologies diverge–there is no ‘one-size-fits-all’ for vital signs alarm thresholds.

 

One of the key challenges with keeping vital signs alarms quiet is that patients’ physiologies diverge, and their conditions change during their stays in the ICUs whether from condition or interventions. Historical vital signs data show that patients ‘drift’ in and out of the default threshold limits set on the vital signs monitoring devices in the units. Some of the most advanced institutions have launched (one-time) initiatives to monitor historical data to identify a more optimized set of device parameters. However, while spreadsheet analysis, expert intuition, and one-off projects may provide temporary relief, entropy eventually sets in and reverts to the status quo: lack of momentum, sustainability, scale, and technology required for system-wide change.

 

Technology can help . . . when it’s not causing the problem.

 

Ascom, a healthcare corporation focused on mobile workflows, introduced ‘silent mode’ technology, which delivers alerts from silenced medical devices to designated clinicians’ smartphones, dashboards and/or PC monitors. That’s good news for patients who benefit from a quiet recovery environment. And good news for clinicians who need near-real time data. However, though this solution addresses the noise issue, it doesn’t necessarily remove the issue of cognitive overload and alert fatigue for clinicians. The flood of alarms, while silent, still necessitate triage and review by the alerted clinician.

There are many vital signs device companies (Philips Healthcare, GE Healthcare, Spacelabs, etc.) that are looking to reduce overall alarms with new features, dashboards, and alerts. They’re trying to fix the problem that their own devices created! Their efforts are genuine, but their methods are off. Much of the work is focused on silencing noise from a given device but not the constellation of devices that are all generating false positives. Healthcare technologies need to consider both patient and provider in order to have the greatest impact on healthcare evolution/revolution. 

 

Data Science and AI are key in this vision.

 

Researchers, clinical thought leaders, data scientists, and administrators have worked on the issue of alarm fatigue for decades. It’s a complex and corrosive issue with lots of data, challenging constraints, and plenty of ‘noise.’ It’s no wonder we’ve seen a decrease in progress from prior work, as data flows are only getting larger, never smaller. AI is key to identifying and implementing adaptive alarm settings, for it can consume massive amounts of patient vital signs, identify trends in the clinical data, and alert medical staff only when absolutely necessary. By decreasing erroneous alerts, AI will empower the clinicians to reduce the noise level and cognitive load in the ICU, benefiting hospitals, clinicians, patients, and their families. The vision of a quiet ICU may have once seemed like a distant dream, but with the help of advancing technology, and specifically AI, it is now within reach. 

 

Conclusion

 

The team from CalmWave is no stranger to AI technology aimed at reducing noise. After finding success in the elimination of alarm fatigue in the Enterprise IT sector for Fortune 100 companies, our team is utilizing similar AI technologies and methodologies to achieve the goal of a quiet ICU. The first area we’re addressing is vital signs alarm thresholding. Our data science powered algorithms take into consideration historical data across the department, as well as the individual patient, in real-time.  This information updates in real time to suggest more precise and accurate vital signs parameters to the clinicians, while providing additional insights on the patient’s trending condition.

As AI technology continues to become integrated into healthcare, hospitals will be able to provide better care and support for clinicians, patients, and their families in the ICU. Request a demo today to see how your hospital can move towards a quiet ICU.

 

Sources:

 

1. Cvach et al., Decreasing PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction.
2. Cvach, Monitoring Alarm Fatigue: An Integrative Review.
3. Cvach et al., Technological Distractions (Part 2): A Summary of Approaches to Manage Clinical Alarms With Intent to Reduce Alarm Fatigue.
4. Cvach et al., Using Data to Drive Alarm System Improvement Efforts.
5. De Waele, Estimation of the patient monitor alarm rate for a quantitative analysis of new alarm settings.
6. Liu, Research of Methods to Reduce Alarm Fatigue of Monitoring System.
7. Van Rossum, Adaptive threshold-based alarm strategies for continuous vital signs monitoring.
8. Wilken, Alarm Fatigue: Using Alarm Data from a Patient Data Monitoring System on an Intensive Care Unit to Improve the Alarm Management.
9.  Ascom, Silent Medical Alarms.
10. Stankov, Sunčica and Bogdan Stepančev, Noise and its influence on human health
11. Rush University Medical Center, Effect of Sleep on the Recovery of Patients Admitted to the ICU