For 36 years, I worked at two major teaching hospitals in Boston. I have been on a cancer ward, in an infusion center, inside an MRI and CT scan, in the OR and PACU, the ER, the cardiac ward, the cath lab, and other diagnostic areas—not only as a clinical engineer, but as a patient. I have experienced the courses of treatment, the waiting for discharge orders to go home, trying to sleep at night despite the noise of alarms, and the joy of having a roommate who wanted nothing more than to smother my face with a pillow because I wanted to watch a hockey game, and his television was broken. Poor guy was a Canadian fan, I think.
Like many patients, I have a very low resting heart rate at night—VERY low. So when I was on a telemetry unit, I would constantly trip the lower alarm threshold. Imagine staff continuously coming in to check on me (which I was grateful for) but not making any changes to the lower limit. That meant sleepless nights my entire time in the hospital.
Fast forward a bit and my employer at the time, Boston Medical Center, kicked off an initiative to reduce clinically insignificant alarms. That was a goal I could really get on board with. My team worked very closely with the clinical governance team to help staff understand the importance of individualizing alarm thresholds safely. We used several different means to evaluate the effectiveness of our work, such as alarm data, observing staff, user group discussions, staff education, and in-the-moment training, but the greatest measure of success came from two sources: the sound level in the units themselves, which were much quieter, and the improved scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
Patients were resting more and the staff was less stressed. Talk about a win-win. As we work to support the patient and to ensure safety, it’s vital that we force ourselves to consider the patient’s perspective and take the time to understand the issues facing clinicians to see if we can help with solutions. As health technology management professionals, we have an obligation to insert ourselves into solutions. We want to be recognized for the value we bring, and I encourage you to act. Do not sit by and wait for issues to escalate to the point of a crisis. You all have so much to offer clinicians and patients, and to help influence positive change. Take it from a patient.
James Piepenbrink is the new deputy executive director of the AAMI Foundation. He previously served as director of clinical engineering at Boston Medical Center in Massachusetts.