ABSTRACT
Alarms in the ICU and operating room (OR) sound frequently and 85-99% of cases do not require clinical intervention. As alarm frequency increases, clinicians develop ‘alarm fatigue’ resulting in desensitization, missed alarms, and delayed responses. This is dangerous for the patient when an alarm-provoking event requires clinical intervention but is inadvertently missed. Alarm fatigue can also cause clinicians to: set alarm parameters outside effective ranges to decrease alarm occurrence, decrease alarm volumes to an inaudible level; silence frequently insignificant alarms; and be unable to distinguish alarm urgency. Since false alarm and clinically insignificant alarm rates reach 80-99%, practitioners distrust alarms, lose confidence in their significance, and manifest alarm fatigue. Yet, failure to respond to the infrequent clinically significant alarm may lead to poor patient outcomes. Fatigue from alarm
amplitude and nonspecific alarms from uniform uninformative alarms is the post-monitor problem that can be addressed by understanding the psychoacoustic properties of alarms and the aural perception of clinicians.
Research will be presented from the field of music perception and cognition and how it fits with medical literature to inform alarm development, encompassing the principles of:
- History of alarms (Patterson alarms)
- Pitch ability from novices to absolute pitch perception
- How jazz improvisation principles can be used in alarm development
- The application of opera to the emotional responses of the healthcare environment
- Emerging psychoacoustic principles in alarm design
ABOUT JOE SCHLESINGER
Dr. Joe Schlesinger is an Assistant Professor in the Department of Anesthesiology Division of Critical Care Medicine at Vanderbilt University School of Medicine where he attends in the operating room, neuro ICU, burn ICU, and VA surgical ICU.
After earning his Bachelor of Arts in Music with a concentration in Jazz Piano Performance from Loyola University in New Orleans, Dr. Schlesinger earned his Doctor of Medicine degree from the University of Texas Health Science Center at Houston. He then completed his anesthesiology residency and critical care medicine fellowship at Vanderbilt before joining their faculty in 2013.While in training, Dr. Schlesinger became a Benjamin Howard Robbins scholar and subsequently completed a research fellowship under the mentorship of Dr. Mark Wallace, Director of the Vanderbilt Brain Institute, studying the effects of multisensory training on pulse oximeter pitch perception. This work led to his receipt of the prestigious Society of Critical Care Medicine Education Specialty Award in 2014.
Since then Dr. Schlesinger has expanded his research interests to include human factors engineering, aural perception, temporal precision, alarm development, and patient monitoring. He actively fosters collaboration across the medical center and university in these pursuits, holding adjunct faculty appointments in Vanderbilt’s School of Nursing, Department of Hearing and Speech Sciences, and the division of Biomedical Engineering within the School of Engineering.
Dr. Schlesinger’s scholarship is supplemented by a secondary focus in anesthesiology critical care medicine practice and education in low and low-middle income countries. He is an ambassador to the Critical Care Society of Kenya and has worked with the Harvard Initiative for Global Health in Guyana.