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Multimodal Medical Alarms
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Multimodal Medical Alarms

A special issue of Multimodal Technologies and Interaction (ISSN 2414-4088).

Deadline for manuscript submissions: closed (31 December 2018) | Viewed by 37108

Special Issue Editors

Prof. Jeremy R. Cooperstock

E-Mail Website
Guest Editor
McGill University, Montreal, QC H3A 0E9, Canada
Interests: human-machine interactions; haptic interfaces; sensory perception
Dr. Joseph J. Schlesinger

E-Mail Website
Guest Editor
Vanderbilt University Medical Center, Nashville, TN 37212, USA
Interests: medical alarms; patient safety; multisensory integration

Special Issue Information

Dear Colleagues,

Regulatory bodies have recognized the importance of medical alarm research and development as patient safety goals and a call-to-action in the research community. Nevertheless, despite various efforts to specify standards for audible alarms, e.g., IEC 60601-1-8, significant problems persist with alarm learnability, localizability, (physiology) information transfer, and alarm fatigue. There is growing evidence to suggest that delivery of alarm information via unisensory streams is sub-optimal, often overwhelming the processing ability and exacerbating fatigue of clinicians. Just as audio-only delivery is often problematic, especially in noisy settings, detection of visual alarms also depends on the stimuli being within the viewer’s perceptual field of vision.

In the everyday world, we routinely employ multimodal interaction. In human-computer interface design, multimodal interaction better leverages our human capabilities, and offers advantages such as enhanced flexibility, robustness to recognition error, and improved usability. Similarly, in the cognitively demanding environment of the healthcare setting, multimodal presentation may help overcome some of the challenges of unimodal alarms. From a research point of view, there are many questions that should be addressed. For instance, are the benefits of multisensory integration and facilitation primarily evident with weak stimuli, near the threshold of perception? If so, are these benefits negated in a setting where the auditory stream is extremely suprathreshold, as encountered in typical healthcare settings? What is the optimal combination of sensory streams that could address the problems of perception, localizability, information transfer, and attenuate alarm fatigue? User-related psychophysical studies with clear clinical translation needs to be investigated.

This Special Issue aims to provide a collection of high quality research articles that address broad challenges in both theoretical and applied aspects of multimodal medical alarms – capitalizing on neuroscience and engineering principles to improve patient monitoring, patient safety, and clinicians’ ability to leverage the use of multisensory integration in their clinical practice.

Prof. Jeremy R. Cooperstock
Dr. Joseph J. Schlesinger
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Multimodal Technologies and Interaction is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Human-machine interaction
  • Patient Safety
  • Haptic interfaces
  • Sensory perception
  • Multisensory integration

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Published Papers (7 papers)

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Research

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14 pages, 1373 KiB  
Article
Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes
by Dilip Birdja and Elif Özcan
Multimodal Technol. Interact. 2019, 3(2), 36; https://doi.org/10.3390/mti3020036 - 22 May 2019
Cited by 9 | Viewed by 4948
Abstract
In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive [...] Read more.
In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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29 pages, 36483 KiB  
Article
To Beep or Not to Beep? Evaluating Modalities for Multimodal ICU Alarms
by Vanessa Cobus and Wilko Heuten
Multimodal Technol. Interact. 2019, 3(1), 15; https://doi.org/10.3390/mti3010015 - 9 Mar 2019
Cited by 19 | Viewed by 7088
Abstract
Technology plays a prominent role in intensive care units (ICU), with a variety of sensors monitoring both patients and devices. A serious problem exists, however, that can reduce the sensors’ effectiveness. When important values exceed or fall below a certain threshold or sensors [...] Read more.
Technology plays a prominent role in intensive care units (ICU), with a variety of sensors monitoring both patients and devices. A serious problem exists, however, that can reduce the sensors’ effectiveness. When important values exceed or fall below a certain threshold or sensors lose their signal, up to 350 alarms per patient a day are issued. These frequent alarms are audible in several locations on the ICU, resulting in a massive cognitive load for ICU nurses, as they must evaluate and acknowledge each alarm. “Alarm fatigue” sets in, a desensitization and delayed response time for alarms that can have severe consequences for patients and nurses. To counteract the acoustic load on ICUs, we designed and evaluated personal multimodal alarms for a wearable alarm system (WAS). The result was a lower response time and higher ratings on suitability and feasibility, as well as a lower annoyance level, compared to acoustic alarms. We find that multimodal alarms are a promising new approach to alert ICU nurses, reduce cognitive load, and avoid alarm fatigue. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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12 pages, 3760 KiB  
Article
CheckMates, Helping Nurses Plan Ahead in the Neonatal Intensive Care Unit
by Jesper van Bentum, Deedee Kommers, Saskia Bakker, Miguel Cabral Guerra, Carola van Pul and Peter Andriessen
Multimodal Technol. Interact. 2019, 3(1), 14; https://doi.org/10.3390/mti3010014 - 9 Mar 2019
Cited by 1 | Viewed by 3629
Abstract
Workflow in a neonatal intensive care unit (NICU) is relatively unpredictable, which makes it difficult to plan activities. Simple tasks, such as checking device statuses may be forgotten, resulting in disturbing alarms. In this paper, we will present CheckMates, ambient lighting displays, which [...] Read more.
Workflow in a neonatal intensive care unit (NICU) is relatively unpredictable, which makes it difficult to plan activities. Simple tasks, such as checking device statuses may be forgotten, resulting in disturbing alarms. In this paper, we will present CheckMates, ambient lighting displays, which visualize device statuses to provide nurses with more overview. We performed expert reviews to obtain insights into the different potentials of CheckMates. Additionally, we performed a simulation study to gather user experiences regarding the functioning of CheckMates and their capacity to improve planning in an NICU environment. The results showed a variety of potential benefits for increasing nurses’ overview of device statuses and their opportunities for workflow planning. Furthermore, CheckMates did not appear to be distracting. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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8 pages, 1139 KiB  
Article
Reducing Redundant Alarms in the Pediatric ICU
by Maya Dewan, Lindsay Cipriani, Jacqueline Boyer, Julie Stark, Brandy Seger and Ken Tegtmeyer
Multimodal Technol. Interact. 2019, 3(1), 11; https://doi.org/10.3390/mti3010011 - 23 Feb 2019
Cited by 5 | Viewed by 4467
Abstract
Physiologic monitors generate alarms to alert clinicians to signs of instability. However, these monitors also create alarm fatigue that places patients at risk. Redundant alarms have contributed to alarm fatigue without improving patient safety. In this study, our specific aim was to decrease [...] Read more.
Physiologic monitors generate alarms to alert clinicians to signs of instability. However, these monitors also create alarm fatigue that places patients at risk. Redundant alarms have contributed to alarm fatigue without improving patient safety. In this study, our specific aim was to decrease the median percentage of redundant alarms by 50% within 6 months using the Model for Improvement. Our primary outcome was to lower the percentage of redundant alarms. We used the overall alarm rate per patient per day and code blue events as balancing metrics. We completed three Plan-Do-Study-Act cycles and generated run charts using standard industry criteria to determine the special cause. Ultimately, we decreased redundant alarms from a baseline of 6.4% of all alarms to 1.8%, surpassing our aim of a 50% reduction. Our overall alarm rate, one of our balancing metrics, decreased from 137 alarms/patient day to 118 alarms/patient day during the intervention period. No code blue events were determined to be related to incorrect setting of alarms. Decreasing redundant alarms is safe and feasible. Following a reduction in redundant alarms, more intensive alarm reduction methods are needed to continue to reduce alarm fatigue while keeping patients safe. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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16 pages, 325 KiB  
Article
Living and Working in a Multisensory World: From Basic Neuroscience to the Hospital
by Kendall Burdick, Madison Courtney, Mark T. Wallace, Sarah H. Baum Miller and Joseph J. Schlesinger
Multimodal Technol. Interact. 2019, 3(1), 2; https://doi.org/10.3390/mti3010002 - 8 Jan 2019
Cited by 7 | Viewed by 4897
Abstract
The intensive care unit (ICU) of a hospital is an environment subjected to ceaseless noise. Patient alarms contribute to the saturated auditory environment and often overwhelm healthcare providers with constant and false alarms. This may lead to alarm fatigue and prevent optimum patient [...] Read more.
The intensive care unit (ICU) of a hospital is an environment subjected to ceaseless noise. Patient alarms contribute to the saturated auditory environment and often overwhelm healthcare providers with constant and false alarms. This may lead to alarm fatigue and prevent optimum patient care. In response, a multisensory alarm system developed with consideration for human neuroscience and basic music theory is proposed as a potential solution. The integration of auditory, visual, and other sensory output within an alarm system can be used to convey more meaningful clinical information about patient vital signs in the ICU and operating room to ultimately improve patient outcomes. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)

Other

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6 pages, 308 KiB  
Brief Report
ECG Monitoring during End of Life Care: Implications on Alarm Fatigue
by Sukardi Suba, Cass Piper Sandoval, Xiao Hu and Michele M. Pelter
Multimodal Technol. Interact. 2019, 3(1), 18; https://doi.org/10.3390/mti3010018 - 13 Mar 2019
Cited by 4 | Viewed by 6698
Abstract
Excessive numbers of clinical alarms in the intensive care unit (ICU) contribute to alarm fatigue. Efforts to eliminate unnecessary alarms, including during end of life (EOL) care, are pivotal. This study describes electrocardiographic (ECG) arrhythmia alarm usage following the decision for comfort care. [...] Read more.
Excessive numbers of clinical alarms in the intensive care unit (ICU) contribute to alarm fatigue. Efforts to eliminate unnecessary alarms, including during end of life (EOL) care, are pivotal. This study describes electrocardiographic (ECG) arrhythmia alarm usage following the decision for comfort care. We conducted a review of electronic health records (EHR) in patients who died and had comfort care orders that were in place during our study. The occurrences of ECG arrhythmia alarms among these patients were examined. We found 151 arrhythmia alarms that were generated in 11 patients after comfort care was initiated: 72% were audible, 21% were manually muted, and 7% had an unknown audio label. Level of alarm: 33% crisis, 58% warning, 1% message, and 8% were labeled unknown. Our report shows that ECG monitoring was commonly maintained during the EOL care. Since the goal of care during this phase is for both patient and family comfort, it is important for the clinicians to weigh the benefits versus harms of the continuous ECG monitoring. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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10 pages, 443 KiB  
Perspective
Improving Human–Computer Interface Design through Application of Basic Research on Audiovisual Integration and Amplitude Envelope
by Sharmila Sreetharan and Michael Schutz
Multimodal Technol. Interact. 2019, 3(1), 4; https://doi.org/10.3390/mti3010004 - 22 Jan 2019
Cited by 11 | Viewed by 4532
Abstract
Quality care for patients requires effective communication amongst medical teams. Increasingly, communication is required not only between team members themselves, but between members and the medical devices monitoring and managing patient well-being. Most human–computer interfaces use either auditory or visual displays, and despite [...] Read more.
Quality care for patients requires effective communication amongst medical teams. Increasingly, communication is required not only between team members themselves, but between members and the medical devices monitoring and managing patient well-being. Most human–computer interfaces use either auditory or visual displays, and despite significant experimentation, they still elicit well-documented concerns. Curiously, few interfaces explore the benefits of multimodal communication, despite extensive documentation of the brain’s sensitivity to multimodal signals. New approaches built on insights from basic audiovisual integration research hold the potential to improve future human–computer interfaces. In particular, recent discoveries regarding the acoustic property of amplitude envelope illustrate that it can enhance audiovisual integration while also lowering annoyance. Here, we share key insights from recent research with the potential to inform applications related to human–computer interface design. Ultimately, this could lead to a cost-effective way to improve communication in medical contexts—with signification implications for both human health and the burgeoning medical device industry. Full article
(This article belongs to the Special Issue Multimodal Medical Alarms)
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