The implications of probability matching for clinician response to vital sign alarms: a theoretical study of alarm fatigue

Abstract

Alarm fatigue has been recognised as a significant health technology safety risk. ‘Probability matching’, in which clinicians respond to the alarm at a rate identical to the perceived reliability of the alarm, has been postulated as a model to explain alarm fatigue. In this article, we quantitatively explore the implications of probability matching for systolic blood pressure alarms. We find that probability matching could have a profound effect on clinician response to the alarm, with a response rate of only 8.6% when the alarm threshold is 90 mm Hg and the optimal threshold for a systolic blood pressure alarm would only be 77 mm Hg. We use the mathematical framework to assess a mitigation strategy when clinicians have a limit to the capacity to respond. We find that a tiered alarm in which clinicians receive information on the severity of vital sign perturbation significantly improves the opportunity to rescue patients.

Practitioner Summary: Using a theoretical model, we predict that probability matching, a postulated model of clinician behaviour, can result in a profound decrease in clinician response to alarms for decreased blood pressure. A mitigating strategy is to create alarms that convey information on the degree of vital sign perturbation.

Keywords::

• clinical alarms
• alarm fatigue
• probability matching
• Bayesian model
• systolic blood pressure

Acknowledgements

This article originated with research done in partial fulfilment of the requirements for the Master of Biomedical Informatics degree from the Oregon Health and Science University. The author wishes to thank his capstone project advisor, Dr. Vishnu Mohan, for his guidance in the completion of his capstone project, which was the impetus for this research.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

Financial support for this study was provided under contract with Northeast Georgia Health System. The funding agreement ensured the author's independence in designing the study, interpreting the data, writing and publishing the report. The author is employed by the sponsor.