How cognitive systems engineering plays a role in re-thinking hospital alarm system design

Michael Rayo

TDAI affiliate Michael Rayo is using his extensive expertise in cognitive systems engineering and data analytics to design and build cognitive tools that improve overall system resilience. His solutions use computational and representational data transformations to design cognitive tools to improve overall system performance over the widest possible range of expected and unexpected conditions.

Building new things has always been an interest to Dr. Rayo, from his early interest in interactive software design to his graduate school training which focused on alarm design, and now his most recent work on AI and visualization-embedded decision support systems. He was offered an opportunity to design alarms for the The Ohio State University Wexner Medical Center (OSUWMC) shortly after he graduated with his PhD., where there was a large push to rethink alarm system design with a specific focus on cardiac alarms. Rayo says, “We wanted to push the limits and design a larger set of alarms that could also help industry partners in the future.”

Rayo wondered what the effect would be of having all alarms from a given source share the same timbre, and designing specific timbres for each alarm source. This would, in effect, make each alarm source sound like its own distinct instrument. “Timbre is the property that we assign to an auditory signal that is outside of all other descriptions like pitch or duration,” explains Rayo. He and Steve Simula, a designer from the research firm Lextant, used this strategy to design alarms for the 11 most important events for OSUWMC acute care nurses. They designed 7 new alarms that utilized 4 different timbres.

Dr. Rayo and his colleagues recently published the results of this research in the journal, Ergonomics. Because clinical alarms are frequently misidentified, Rayo and his team found that alarm identification improved when they made “alarms more acoustically rich, using timbre to convey alarm groups, and explicitly [encoded] intended urgency improved identifiability and urgency.” In the study, identifiability and the perceived urgency were compared for two sets of alarms in a healthcare setting. One contained alarms familiar to nurses wherever possible, with new sounds added if needed. The other set was all newly-designed alarms, which were more heterogeneous and used timbre to encode the similarities and the intended urgency across the set. The timbre-based alarms were identified more readily, even though they had never been heard before the experiment. These findings can help improve alarm performance across all safety-related industries.

“Right now, all of the alarms coming through phones at the Wexner Medical Center are from the research we did. From the research side, we added to knowledge that will help alarm designers across the board,” says Rayo.

In July 2019, The New York Times published an article discussing the efforts of Dr. Rayo and colleagues in assisting Dr. Judy Edworthy of the University of Plymouth to create a new worldwide auditory clinical alarms standard. The team combined extensive science on auditory alarm perception and response with innovation in alarm design to make alarm simultaneously more identifiable and less startling. Dr. Rayo’s timbre-based alarm strategy is complementary with Dr. Edworthy’s earcon strategy (which can be heard in the NY Times article). Rayo notes that his study is, “Part of a larger movement to keep adding to the list of strategies we know will increase alarm effectiveness and our ability to evaluate the new alarms that are continuously being developed.”

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