Alarms don’t need to sound like alarms as we know them to be effective.
Judy Reed Edworthy, Professor Emerita of Applied Psychology, Plymouth University, UK
Judy Reed Edworthy, Professor Emerita of Applied Psychology at Plymouth University, UK, carried out research, design and implementation work in the area of auditory alarms for many years. We interviewed Judy as ‘Godmother of alarms’, a name originally given to her by research colleagues and which she has now adopted for herself. Her story underlines an important similarity with the mission of itemedical as a software company focusing on innovative healthcare solutions. We both have a common goal: reducing false alarms and reducing the problem of alarm fatigue in medical environments. Edworthy’s groundbreaking research showed that alarms don’t have to make traditional beep sounds to be effective. Instead, they can be designed to be more intuitive and less intrusive, improving their functionality and user experience.
Read more about Judy Edworthy’s progressive approach and remarkable findings ultimately creating a safer and more efficient healthcare environment.
Favorite alarm research project
Judy Reed Edworthy has been involved with multiple projects about the design, application, and underlying theory of alarms. Which have been her favourite projects? Judy: “The best work I’ve done was a piece of research in the 1990’s on the perceived urgency of sound. My PhD student and I looked at all the parameters that could impact urgency of an alarm, like pitch change and speed change. Almost everyone who has researched alarms has cited our work ever since and it underpins many studies.”
Beyond traditional beeping alarms
Judy: “In terms of my most surprising discovery, it’s not so much the results of research that surprise me, but rather the implications of that research. An example of this is the project I worked on to update IEC standard 60601-1-8:2006, recommending the use of meaningful, real-world sounds for medical device alarms. The key implication of this project was that alarms don’t need to sound like alarms as we know them to be effective.”
Current alarm sounds are uninformative, difficult to differentiate from other alarms and irritating.
Innovative medical alarm tones
The new alarm tones created by Judy are now included in the standard IEC 60601-1-8:2006. Judy explains why it is so important to change current medical device alarm sounds. Judy: “Current alarm sounds are uninformative, difficult to differentiate from other alarms and irritating. The new IEC 60601-1-8:2006, published as an update in 2020, is a global standard for medical electronic equipment which was partly informed by my research into alarm sounds. I developed sounds which are more relatable and less intrusive to be used by medical device manufacturers. My research showed that these sounds were better than existing beeps (ISO/TC 121/SC 3 – Respiratory devices and related equipment used for patient care).”
We are conditioned to think of an alarm as a beep.
Judy: “The reason why alarms sound as they do currently is because of the technology that was available to reproduce them. Alarms used to be created with very basic technology which meant a beep was really the only option. That has become embedded in our culture now, we are conditioned to think of an alarm as a beep. However, we have proven that it does not need to be this way.”
Real-world alarm sounds
“We have evolved to listen in a certain way and the current alarm beeps are not easy to listen to, we must create an association in our brains between an alarm and the cause of the alarm. However, if you use real world sounds, our brain can already localise and identify the cause. It is easier to learn and remember real world sounds that we are used to listening to than it is to associate artificial beeps. Many of the problems associated with alarms, including alarm fatigue, are linked to the poor alarm sounds.”
The biggest issue is false alarms, but the design of the alarm sounds is also an important factor.
Definition of alarm fatigue
How would you define the phenomenon called alarm fatigue? Judy: “The degree to which a person is prepared to or able to attend to an alarm as a function of a range of factors including false alarm rate, the sensitivity of the alarm, whether the alarm signal is heard or able to be heard, whether it is identifiable, and individuals’ personality factors. Alarm fatigue is a problem with alarms caused by a set of issues that are not calibrated properly, it is a symptom of multiple different causes. Each of these causes can be addressed. I feel quite certain that the biggest issue is false alarms. But it is not the only issue, the design of the alarm sounds is also an important factor.”
People tell me that they can still hear alarms at home when there is no alarm.
Impact of alarm fatigue
From your research and experience, what are the impacts of alarm fatigue? Judy:
“People tell me that they can still hear alarms at home when there is no alarm. I think we should start calling these ‘alarm worms’, like ear worms but specifically for alarms. Imagining alarms is caused by the frequency of which the person has heard alarms. We know that people match their response to alarms with what they perceive the false alarm rate to be. But I think there are up to 9 or 10 other factors involved in alarm fatigue and we are not clear on their relative importance in alarm fatigue.”
Vision of the future
What do you think the future hold for device alarms and alarm fatigue? Judy: “It’s a difficult one for me as I’m focused on the alarm sounds, but the end goal is that there are no alarm sounds, we want there to be as few alarms as possible. If there are sounds, I want them to be nice sounds, but I am not sure of the extent to which that will happen. I know of hospitals that are working towards silent alarms and I know that some device manufacturers are using our real-world alarm sounds to some extent. People are becoming more interested in alarms and alarm sounds so I hope that the future will bring fewer alarms with more meaningful sounds that are easier to learn and localise.”
Conclusion
Edworthy’s findings underline itemedical’s choice to make alarms from the care phone, the Medical Alarm System (MAS) freely configurable to ensure that alarms are not only reliable but also easy to use, minimizing the cognitive burden for healthcare providers and improving outcomes for patients will be improved. This synergy between research and application highlights itemedical’s commitment to advancing medical technology through evidence-based practices, ultimately creating a safer and more efficient healthcare environment.
Interested in reading more about alarm fatigue?
Judy Reed Edworthy recommends two papers:
- Claudio, D., Deb, S., and Diegel, E. (2021) ‘A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff’, Critical Care Explorations, 3(6), doi: 10.1097/CCE.0000000000000464.
- McNeer, R. R., Horn, D. B., Bennett, C. L., Edworthy, J. R., & Dudaryk, R. (2018). Auditory icon alarms are more accurately and quickly identified than current standard melodic alarms in a simulated clinical setting. Anesthesiology, 129(1), 58-66.
Judy’s biography revealed
“My background is a degree in Psychology, a degree in Music and a PhD in the cognitive processing of music. I then spent time working at the Applied Psychology unit in Cambridge, where I worked on my music research but also began working on alarms. This was back in 1983. I saw a niche for experimental psychology in alarms, a small number of acousticians were researching alarms, but the psychology aspect hadn’t been tackled at all. From that time onwards, I have worked on projects around design, application, and theory of audible alarms across multiple industries like healthcare, chemical processes, trains, fixed-wing aircraft and helicopters, nuclear power and space travel. I think I am most known for my alarms work but I have done a lot of other projects and research for example, I’m currently working on a project in Australia to design a new sound for electric buses.”