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Alarms in medical equipment

th.id.au

111–118 of 118 posts

Re: Alarms in medical equipment

#111
post #15

Earlier quoted context omitted.

Many of those companies fall into the trap of “well, we’d rather a noisy alarm that catches the problem than a silent one that doesn’t.” Both are problems. The former just makes management feel like a problem would be caught be the on-call.

The ventilator company I worked for tried very hard to avoid false positives because we were very concerned about alarm fatigue. We also tried to ride the line on false negatives. It’s really hard. Sometimes the alarm limits are set incorrectly by the RT or aren’t forgiving enough to allow some motion. When you see an entire ward of nurses totally ignoring alarms it’s a management failure. Either there aren’t enough…

The day I encountered it I have no idea of what sensitivity controls might have existed but the problem was unquestionably the system failing to recognize that what had just transpired was a beat. The trace on the screen looked like a beat to me, but not always to it.

I will not say it was a management failure because I don't know if management could have done anything about it. Given the total indifference of the nurses I strongly suspect they couldn't do anything.

Re: Alarms in medical equipment

#112
post #20
post #9

Earlier quoted context omitted.

False positives are definitely a problem. When you read industrial accident reports one extremely common theme is some sensor that was notifying the controller of the problem, but that sensor had a history of false positives so it was disregarded. Companies that don't take false positives seriously are inherently dangerous.

It's hard to solve the problem of false positives when the decision to sound an alarm is reliant on a single sensor that may start to become detached (e.g. glue/tape failure). If you think the solution is multiple sensors, well, what happens when one sensor indicates an alarm condition and the other doesn't? Now you have another potential false positive. Not to mention it's untenable to connect twice as many leads to…

That could partially be addressed by making the sensor include the concept of not working. Run a small electric current across the sensor, if that current fails the sensor knows that it's not monitoring and can report it as a loose sensor rather than as a failure of whatever it's supposed to be sensing.

Re: Alarms in medical equipment

#113

And how about the fact that there are simply too many of them! I was once in the recovery room with my wife. For some reason the sensor was having a very hard time reading her pulse. The normal bips would frequently fail. Too many failures in a row and the alarm would start it's EEEEEE scream we've all seen from Hollywood. It would shut up as soon as it managed to pick up a beat. Hers was definitely not the only one…

There will always be false positives and false negatives, they have to be balanced. If the cost of a actual negative is 100 and the cost of an actual positive is 1. You'd expect there to be approximately 100 times more false negatives, because we want to be 100 times more sensitive to the costly negative condition. I'm this sense, the alarms in hospitals make sense. Actual negative are very costly. But this is a cold…

You have it backwards.

They really do not want false negatives because that gets them sued. Thus the system will be set up to err on the side of false positives--the current liability climate does not blame them for alarm fatigue.

Consider a local case (although it's possible it was overturned on appeal): Yes, the doctor was unquestionably playing loose with standard safety precautions. His behavior transmitted blood-borne infections. He died in prison which was well deserved.

However, the lawyers went hunting for some deep pockets. The manufacturer of the drug involved in the cross contamination. They made various size vials, including some that were bigger than would be used on one patient. This permitted the doctor to contaminate between patients and got them hit with a $250M verdict. (Never mind that had they truly only used clean needles with them like they should have there never would have been an issue. They used a new needle but the old syringe.)

That's the sort of insane legal pressure driving the garbage.

Re: Alarms in medical equipment

#114
post #79
post #40

Earlier quoted context omitted.

What would have happened if the medic didn't notice and the patient died? Would you have got the blame for ignoring it, or management for creating a situation where you had no choice but to ignore some alarms because of false positives, or the manufacturer, or would it have been swept under the rug as "the patient was having heart failure and unfortunately even our state-of-the-art medical care couldn't save him"? Al…

There would definitely be an investigation, as all sentinel events are investigated. Management would do their RCA and I'm sure the issue with alarm fatigue would be ignored or underplayed (Something bad happen? make sure an alarm sounded. If staff ignored it, it must be the fault of the staff). I doubt any one person would be in trouble as it was a collective/systemic failure, but I don't know exactly what would hav…

They will try as hard as they can to pin system failures on the unfortunate person who was in charge of the system.

Or, a local case, the nurses were complaining about shoddy supplies. Eventually the holes in the swiss cheese lined up and a baby died. The hospital tried to treat it as a murder by the nurse. (Claiming the line was cut, rather than it broke.)

Re: Alarms in medical equipment

#115
post #50

Earlier quoted context omitted.

Hospitals have a sort of manic "New York Stock Exchange" energy and environment to them... The entire environment of a modern hospital seems brutally incompatible with the type of peaceful relaxing environment you'd want to reduce stress and improve patient outcomes. Bright lights, constant noise, loud electronics, preventing patients from sleeping based on whatever schedule is convenient to medical staff, etc. I thi…

Hospitals are not "peaceful relaxing environments". They are large scale industrial operations designed to process as many people as possible. There simply aren't enough resources to afford every single person a "relaxing environment". You do the best you can for as many as you can. All this "relaxation" stuff will quickly be converted into spare capacity the second large numbers of severely wounded people start show…

I suspect the patients would fare better if active noise cancelling headphones were issued to every patient.

Re: Alarms in medical equipment

#116

Earlier quoted context omitted.

this is very true with diabetes equipment since there is constant alerts (for example from insulin pumps) of low battery, undelivered insulin, etc. I think it definitely helps to give users the right amount of control if it's non life critical like a CGM or for insulin delivery.

Insulin delivery is considered life critical by the FDA, because the failure modes of those devices can involve coma, brain damage, and even death. Some of those alarms will still be hardcoded, and for good reason!

I agree, but something like "incomplete bolus" doesn't really make sense to me and I think those types contribute to alarm fatigue. The key issue with T1 diabetes is hypoglycemia, which can cause acute damage and death, so in theory not having insulin on isn't as big of an issue (assuming the patient is actually trying to control their disease and checks blood sugar etc, in the alternate case the alarms probably don't help much). Of course, I agree something like a hypoglycemia alarm is important

Re: Alarms in medical equipment

#117

Earlier quoted context omitted.

Negotiate? Just quit. At some point you're better off doing literally anything else with your limited time on this earth. Way too much time and effort for too little reward. Who's looking forward to doing a decade of hard training only to end up with some 9-5 job and salary? That's just absolute nonsense. Becoming a doctor is quite simply a stupid decision if you're not gonna get rich off it. You're replying to a cit…

Your profile indicates this is Brasil... Let me do a quick Google search. "[T]he Brazilian healthcare system has achieved significant success in improving population coverage, reducing infant mortality rates [a 4-fold drop!], and controlling infectious diseases." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231901/ It sounds like doctors are actually doing a much better job there nowadays than they were 35 years ag…

Even the article you cited contains allusions to the truths I will write about in this comment. "Unequal access to healthcare services and resources", "significant disparities in healthcare outcomes between different regions" and the most hilarious point of all... "Low quality of care". Just lovely.

Let's rid ourselves of all these polite euphemisms though. Here's a likely incomplete list of all the things that you don't see.

What you don't see is the communist president of the worker's party who is literally quoted saying "we need to create a new generation of leftist doctors who accept working for less". Population needs doctors, and they vote, so give them what they want: more doctors. And when you want quantity, then obviously you also want cheap. Flood the market with doctors, open hundreds of new schools with ever more lax filters and bring in doctors from neighboring countries too even though they seem to be in even worse shape than us. Problem solved, look at all those happy voters.

The government's latest move was to remove doctors from the decision making positions that control residencies in an obvious preparation to flood the market with "specialists" by dumbing down the requirements and opening new residency programs, no doubt without any concern for quality. You might be skeptical about this claim but these are people who are stupid enough to believe a nurse with 10 years of job experience is equivalent in knowledge and skill to a doctor. At least one such "illustrious" politician can be directly quoted on that.

There's already a huge number of medics, they just happen to be concentrated in the major cities and capitals. The simple fact is nobody wants to live in some undeveloped shithole. Living in Brazil to begin with is punishment enough, there just aren't many maniacs around here who are willing to work and live in the literal amazon jungle. Even comically high salaries fail to attract doctors to areas like that. Partly because quality of life is abysmal and partly because those little villages are so poor they're actually likely to default on those payments anyway so there's no point. Those are the places where the government wants to ship doctors off to though. You'd think they'd develop the country instead so that people in general would want to move there but that's too difficult. Better to just destroy the profession of the "mercenary" doctors instead until they're so squeezed they have little choice.

You don't see the hundreds of brazilian medical schools soaking up billions in government student loans while providing mediocre education. Student loans are very efficient at making school administrators very wealthy. They were devastating for academic integrity everywhere in the world including the US but this country always manages to make it worse by not even pretending to give a shit about quality. In the US medicine apparently escaped that fate due to stronger regulation. In Brazil? So many of these medical schools do not even have an actual hospital for medical students to practice on. How do you become a doctor without seeing patients? You don't.

You don't see the palpable pessimism in health care workers, as a class. What was once a profession that guaranteed prosperity turned into essentially a joke. Doctors generally do not recommend that their children follow in their footsteps. Why would they want their children to bust ass in medical school just to make six dollars a patient? That's just stupid. And those are the lucky ones. The family medicine workers of the study you cited usually make even less than that. This new generation of doctors is feeling the pressure, meanwhile older generations of doctors are taking the wealth they built up and bootstrapping actual businesses instead.

You don't see the 40 thousand newly minted doctors of dubious quality entering the job market every single year. That obviously brings about difficulties with job and residency availability, not to mention the massive and constant downward pressure on salaries. So how does the typical newly minted doctor react to this adversity? Charlatanism.

You don't see the rampant charlatanism on social media. Social media platforms are absolutely filled with them. "Professionals" promising miracle cures, promising results, just basically doing everything that medical ethics says they can't do. That includes passing themselves off as specialists while having a fraction of the education, or just straight up advertising "specialties" they just made up on the spot.

Hilariously, these charlatans are actually the ones who are making it in this distorted reality. They do things like charge people thousands for aminoacid injections that literally do nothing. Brazilian medicine regressed to literal "blow smoke up people's ass" charlatanism and these people are getting rich off it. Do you know what coffee enemas are good for? I haven't the slightest clue but you bet there are doctors doing that to patients literally right now. Things are so screwed up even non-doctors, people who have never stepped foot in a medical school let alone an operating room, have grown bold enough to do "simple procedures" on their customers.

Ever seen an unemployed doctor? Ever seen doctors become Uber drivers? Cashiers? I have. It used to be a meme. Then it actually started happening. Salary only ever decreases. We have emergency services paying the lowest and ever decreasing salaries. What kind of doctor do you think that's going to attract? The simple fact is there aren't enough hospitals in this country for all of them. Most of the ones we do have are in such disrepair that nobody sane would actually want to work there.

The decentralized public health care system familiy medicine situation is even more precarious. There are workplaces in this country that do not have a working sink for doctors to wash their hands with. You simply cannot exercise your profession with dignity under such conditions. The smarter, better doctors have better options and don't subject themselves to that. The ones manning the public health system are generally the desperate and indebted ones. The ones who weren't good enough to match into a good residency.

You don't see the criminally stupid doctors who fuck up so bad they end up on national television. Doctors working an ER who are so stupid they don't run a simple EKG on a patient with textbook myocardial infarction symptoms. Imagine being this fuckup's lawyer. And it's not an isolated case either, their numbers are increasing. The fact is in Brazil any moron can become a doctor these days and you better believe it shows. The problem with that is people's loved ones die in the process and there's no amount of damages that will bring them back. A few years ago I nearly died of appendicitis myself because they initially blamed my symptoms on COVID19. The doctors who saved my life were all older than the public health system the paper you googled talks about. They're becoming rare now, and knowing that makes me afraid of getting sick again.

I seriously hope you reconsider this "just increase supply" nonsense. I know HN hates doctors and it's kind of a tall order but I sincerely hope what I wrote here makes some impact. Simple solutions like that will not accomplish what you want. To put it mildly.

Re: Alarms in medical equipment

#118

Earlier quoted context omitted.

Hospitals are not "peaceful relaxing environments". They are large scale industrial operations designed to process as many people as possible. There simply aren't enough resources to afford every single person a "relaxing environment". You do the best you can for as many as you can. All this "relaxation" stuff will quickly be converted into spare capacity the second large numbers of severely wounded people start show…

I suspect the patients would fare better if active noise cancelling headphones were issued to every patient.

I've yet to see a study that shows noise cancelling headphones reduce patient mortality in any way whatsoever. Until there is such a study, money is better spent on things that are actually known to reduce mortality. Such as drugs.
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