Alarm Prioritization Research Articles

Exploring the Influence of Human System Interfaces: Introducing Support Tools and an Experimental Study

Situational awareness and decision support tools such as procedures and alarm systems are vital for effective interaction among control room operators, especially in safety-critical situations. In safety-critical environments such as process plants, there remains a gap in evaluating specific tools during actual operations, or ”work-as-done.” Additionally, the underlying factors that might impact operators’ cognitive states and performance concerning safety have not been thoroughly explored. The need for such an evaluation is further bolstered by current interaction configurations where operators are more passive than active, thus reducing their cognitive performance. Therefore, this experimental study addresses the highlighted evaluation gap by introducing and comparing three human system interfaces/decision support tools in four human-in-the-loop configurations. The supports include two alarm design formats (prioritized vs. non-prioritized) and three procedure representation formats (paper, screen-based digitized, and an AI-based support system built with an integrated Bayesian network and reinforcement learning model). Ninety-two people (n = 92) participated voluntarily in the test. They were divided equally into four groups. Each group tested three safety-related events in a simulated formaldehyde production facility. Individuals belonging to the group with prioritized alarms and utilized paper procedures rated procedural support slightly higher on average than others in different groups. Unlike the other groups, their assessment of alarm prioritization support remained consistent across all scenarios. Further analysis of the impact of the setup on cognitive states and actual performance will be performed.

Alarm Configuration in Intensive Care Units of a Corporate Hospital

In intensive care units (ICUs), inappropriate alarm configuration practices pose significant challenges to patient safety and healthcare providers. The current practices lack standardized guidelines, resulting in excessive alarms and alarm fatigue, where healthcare providers become desensitized and may miss critical events. The absence of standardized protocols and ineffective alarm prioritization exacerbate the problem. The present study aims to understand the various alarm configuration practices in the Intensive Care Unit and to proactively evaluate the limitations of clinical alarm systems management. It focused on identifying reasons for the occurrence of nuisance and false alarms, factoring in the proportion of these unnecessary alarms, and chalking out measures to reduce these false and nuisance alarms. After months of ICU observation, Alarm desensitization, and Alarm fatigue came out to be eminent issues in the functioning of an Intensive Care Unit. The clamor of alarms has been demonstrated to hinder patient recovery, lengthen stays, have a poor impact on patient satisfaction, and cause patient anxiety, sleep difficulties, delirium, elevated blood pressure and heart rates, and immune system deterioration. Therefore, fewer alerts and a simpler alarm configuration procedure can aid in better patient outcomes. The response to all alarms is imperative but false and nuisance alarms make it challenging for the nurses to differentiate and respond to genuine alarms. The study focused on identifying reasons for the occurrence of nuisance and false alarms, factoring in the proportion of these unnecessary alarms, and chalking out measures to reduce these false and nuisance alarms. This included a checklist to monitor the alarms in ICUs on a daily basis for various equipment including cardiac monitors, ventilators, dialysis machines, syringe pumps, and infusion pumps. These were monitored for around 5 hours a day and the analysis revealed most of the equipment especially cardiac monitors giving out false and nuisance alarms. A pre-assessment questionnaire was made to assess the knowledge and perception regarding clinical alarms for nurses. The analysis revealed that 40% of nurses could not differentiate between false and nuisance alarms.

Enhancing Alarm Prioritization in the Alarm Management Lifecycle

Despite significant improvements being made in control and safety systems, near-miss incidents and adverse accidents continue to occur in the industry. Indeed, humans have a vital role in process control success or failure due to their responses to abnormal situations and alarms. A broad study on the alarm system performance shows that good rationalization and accurate prioritization of alarms should increase the efficacy of alarm systems and improve operator decision performances. This paper discusses current gaps in alarm prioritization approaches. It then proposes a method based on Graph theory and metrics capabilities to facilitate and improve the alarm prioritization process. The method is developed based on the causal and layer of protection modeling, followed by measuring the graph metrics for prioritization purposes. Finally, the proposed method is evaluated through implementation in a simulated case study. Results show that this approach facilitates similar achievement to the alarm workshop and produces more valuable data to the cascade of abnormal situations in a structured method and shorter time.

Lessons from the Glass Cockpit: Innovation in Alarm Systems to Support Cognitive Work.

Nurses working in the hospital setting increasingly have become overburdened by managing alarms that, in many cases, provide low information value regarding patient health. The current trend, aided by disposable, wearable technologies, is to promote patient monitoring that does not require entering a patient's room. The development of telemetry alarms and middleware escalation devices adds to the continued growth of auditory, visual, and haptic alarms to the hospital environment but can fail to provide a more complete understanding of patient health. As we begin to innovate to both address alarm overload and improve patient management, perhaps using fundamentally different integration architectures, lessons from the aviation flight deck are worth considering. Commercial jet transport systems and their alarms have evolved slowly over many decades and have developed integration methods that account for operational context, provide multiple response protocol levels, and present a more integrated view of the airplane system state. We articulate three alarm system objectives: (1) supporting hazard management, (2) establishing context, and (3) supporting alarm prioritization. More generally, we present the case that alarm design in aviation can spur directions for innovation for telemetry monitoring systems in hospitals.

Systematic rationalization approach for multivariate correlated alarms based on interpretive structural modeling and Likert scale

Alarm flood is one of the main problems in the alarm systems of industrial process. Alarm root-cause analysis and alarm prioritization are good for alarm flood reduction. This paper proposes a systematic rationalization method for multivariate correlated alarms to realize the root cause analysis and alarm prioritization. An information fusion based interpretive structural model is constructed according to the data-driven partial correlation coefficient calculation and process knowledge modification. This hierarchical multi-layer model is helpful in abnormality propagation path identification and root-cause analysis. Revised Likert scale method is adopted to determine the alarm priority and reduce the blindness of alarm handling. As a case study, the Tennessee Eastman process is utilized to show the effectiveness and validity of proposed approach. Alarm system performance comparison shows that our rationalization methodology can reduce the alarm flood to some extent and improve the performance.

A distributed approach to alarm management in chronic kidney disease.

This paper presents the feasibility study of using a distributed approach for the management of alarms from chronic kidney disease patients. In a first place, the key issues regarding alarm definition, classification, and prioritization according to available normalization efforts are analyzed for the main scenarios addressed in hemodialysis. Then, the middleware proposed for alarm management is described, which follows the publish/subscribe pattern, and supports the Object Management Group data distribution service (DDS) standard. This standard facilitates the real-time monitoring of the exchanged information, as well as the scalability and interoperability of the solution developed regarding the different stakeholders and resources involved. Finally, the results section shows, through the proof of concept studied, the viability of DDS for the activation of emergency protocols in terms of alarm prioritization and personalization, as well as some remarks about security, privacy, and real-time communication performance.

The Use of Mobile Devices To Improve Alarm Systems

The Joint Commission 2007 Annual Report stated, “Inadequate communication between care providers, or between care providers and patients/families, is consistently the main root cause of sentinel events.”1 Critical components of communication regarding the health status of a patient are the alerts and notifications originating from the various patient monitors; yet according to the American Journal of Emergency Medicine, as many as 99.4% of alarms are false and less than 1% result in change to patient management.2 Looking to 2011, alarm hazards remain an ongoing challenge, listed at number two on the ECRI Institute’s Top 10 Health Technology Hazards for this year.3 This paper addresses how the use of mobile devices such as the iPhone, the Android smart phone, and the Blackberry with intuitive interfaces and messaging coupled with an integrated alarm management platform will improve clinical satisfaction and operational workflow and decrease risk at the point of care.

A risk-based approach to design warning system for processing facilities

Alarm flooding is a major safety issue in today's processing facilities. Important recommendations are available for alarm management; however, they are often violated in practice, especially in the alarm systems implemented through the distributed control system. An effective process alarm prioritization and management system is desired for a safe and effective operation of a process facility. In present work, authors address two main issues related to an alarm system – the reliability and the prioritization of the alarms. The main objective is to deal with the alarm-flooding problem in process facilities. A multi alert voting system based on sensor redundancy approach is proposed to improve the reliability. A quantitative risk-based alarm management approach is proposed to address the flooding issue. In the risk-based approach, an integrated model consisting of the probability ( P), the impact ( I) of the potential hazards, and the process safety time is proposed to prioritize these raised alarms. The proposed approach is further explained by a reactor system with pressure and temperature variable monitoring and controls, where the hazards associated with two alerts caused by over high pressure and over high temperature are analyzed and integrated with response time for alarms generation and prioritization.