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Alarms in medical equipment

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Re: Alarms in medical equipment

#51

Post by mschuster91 »

blackeyeblitzar wrote: post #38
mschuster91 wrote: post #27

Earlier quoted context omitted.

It's a necessity, a side-product of not having anywhere near enough nurses, assistant staff and doctors in hospitals. They're juggling alarms constantly (which have to blare in a cacophony) and speed from one patient to the next. Ideally you'd have a 1:1 (or better!) assignment between a single patient to a single nurse in critical care, 1:3 for patients that can't move around on their own (and thus need more assista…

I don’t disagree but I’m not sure how to make the costs of healthcare work with those ratios

Get rid of bureaucratic bullshit and you'd get > 250 billion $ a year [1]. Get rid of insurances and other middlemen and you'd get another 450 billion $ a year by going for single-payer [2]. Then, get the homeless enrolled in insurance as well - even if the government pays the premium, every single homeless person costs > 18k a year in ER visits [3], a lot of which could be prevented if these people could go to a doctor before they'd be sick enough to incur serious ER costs. And finally, get as many homeless drug addicts back into some sort of stable housing. A lot of drug usage "on the streets" is self-medication to cope with the immense stress that comes from being homeless. Yes, there will always be a certain percentage of hardcore voluntary homeless people, but that's way better manageable than the status quo.

That should be way more than enough to hire enough nurses.

[1] https://www.americanprogress.org/article/excess-administrati...

[2] https://ysph.yale.edu/news-article/yale-study-more-than-3350...

[3] https://www.newsweek.com/homeless-americans-are-costing-us-m...

Re: Alarms in medical equipment

#52

Post by HeyLaughingBoy »

graypegg wrote: post #37
HeyLaughingBoy wrote: post #29

Earlier quoted context omitted.

That's really the problem many here are describing. 60601 mandates what alarms shall be active, but it spans a single device. If you have, e.g., 10 ventilators in a room that are alarming, you can't silence them all with a single button press.

I can kind of understand why it ended up that way. There's some benefit to just assuming, nothing works together. It's at least a consistent state of affairs. You can just wheel in any heart rate monitor, and you only need to understand that heart rate monitor. But it seems like a space that's really ripe for improving. We have very reliable simple protocols you could hook these all into. Imagine it was law that ever…

Interoperability is definitely a problem. I've been in the industry for quite some time, and at one job we got to shadow med lab techs, since they were the operators of the machines that we built. Their workload is insane and after an hour watching them work, I could identify a number of new products that would help them. I brought it up to my management and learned that "marketing is aware of those problems and we're devising solutions." No idea if those solutions ever hit the market -- this was over 10 years ago.

At the time, the solution to interoperability was to buy all your lab equipment from one manufacturer, who would use their own (usually proprietary) protocols to tie things together. That way, at least even if they weren't actually interoperable, the UI's and workflows were mostly consistent.

A large part of the problem is that hospital IT is understandably hostile to anything connecting to their network, so all the stuff we were building at the time that talked to each other, had to use its own standalone network, or serial ports (ugh!).

Standards like IEC-60601 or 62304 (my daily bread) are easier to adopt because they address patient safety. I suspect it would be much harder to mandate an interoperability standard unless you could show that it improved safety instead of "just" making the healthcare provider's job easier. Or maybe it exists, but just never came up on my radar.

Re: Alarms in medical equipment

#53

Post by HeyLaughingBoy »

davidw wrote: post #32
HeyLaughingBoy wrote: post #30

Earlier quoted context omitted.

On the producing or consuming side? FWIW, I found the article interesting as I'm starting a new Oxygenator project so I'm probably about to become even more familiar with IEC60601 :-(

I don't want to work on software where bugs might cost someone their life.

I get that, but it's very unlikely to happen. The benefit of your code vastly outweighs the potential downside. As engineers, we're used to only hearing about the problems. It's really gratifying when you hear from someone who says, "tell your engineers that they saved my life."

Re: Alarms in medical equipment

#54

Post by varjag »

imglorp wrote: post #10
sebmellen wrote: post #6

Earlier quoted context omitted.

GPWS warnings should be the gold standard for any sort of urgent audio alarm. Examples: https://www.youtube.com/watch?v=W5Z-d1Zx02o

At :42 I think the buzzing sound is the "stick shaker" stall warning. It literally shakes the pilot's control yoke. So not only is it an alarm, it's also reminding the pilot of the correction needed: to push the control forward.

Wouldn't that be pull backward?

Re: Alarms in medical equipment

#55

Post by Buttons840 »

LorenPechtel wrote: post #4

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 mathematical analysis that doesn't consider alarm fatigue and the cost of people learning to ignore the alarm. I wonder how to best model human nature in this calculation?

An optimal solution would require considering all alarms, and modeling the fact that every alarm given is another alarm ignored (assuming the hospital is operating at capacity, if it's below capacity the solution is easy, just manually check all alarms). This system might realize that the 4th "no pulse" alarm of the night for Alice would detract from the 1st "no pulse" alarm for Bob, and that Bob's is more likely to need attention. I'd be terrified to program such a system though, and from what I've seen in corporate programming environments, I'm not confident any company could get this right.

Re: Alarms in medical equipment

#56

Post by seabass-labrax »

varjag wrote: post #54
imglorp wrote: post #10

Earlier quoted context omitted.

At :42 I think the buzzing sound is the "stick shaker" stall warning. It literally shakes the pilot's control yoke. So not only is it an alarm, it's also reminding the pilot of the correction needed: to push the control forward.

Wouldn't that be pull backward?

Not in this case, because the 'stick shaker' activates when the aircraft is stalling or close to stalling. The only sensible option in this scenario is to lower the angle of attack, that is, pitch forward. If you have both the GPWS 'terrain, pull up' warning and the stick shaker warning simultaneously then you are in a sticky situation indeed.

Re: Alarms in medical equipment

#57

Post by makeitdouble »

teeray wrote: post #15
jandrese wrote: 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.

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.

Management could be the most relevant part. A silent alarm is management's fault, a wrongly ignored noisy alarm can be pushed as staff's fault.

Re: Alarms in medical equipment

#58

Post by krisoft »

jandrese wrote: post #9
LorenPechtel wrote: post #4

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…

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.

> When you read industrial accident reports one extremely common theme is some sensor that was notifying the controller of the problem, but …

I remember an accident report. It was about a container ship which had a bad flooding incident in their engineering spaces. One thing the report pointed out that the engineers had ways to fight the flooding, but they were not doing them because they were playing whack-a-mole with all the alarms caused by the flood. If i recall correctly the engineers kept ignoring the waist deep and rising water and prioritised silencing the alarms. (And not because they were stupid, but just because the many independent blaring alarms task-saturated them.)

Re: Alarms in medical equipment

#59

Post by Aeolun »

_yb2s wrote: post #50
LorenPechtel wrote: post #4

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…

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…

Don’t think it’s so unrealistic to make a sterile green environment with fake plants. Fairly certain it doesn’t matter too much.

Re: Alarms in medical equipment

#60

Post by nradov »

kelnos wrote: post #18
jandrese wrote: 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.

> Companies that don't take false positives seriously are inherently dangerous. Alarms with incessant false positives are inherently dangerous. Sure, there's some threshold of false positives, under which we should still expect people to investigate all alarms. But above that threshold, how can we continue to blame the people involved? The hardware is at fault.

Please propose a design for better hardware then. You'll make a fortune and do a lot of good in the process.

Seriously, what would motivate you to make a comment like that? Do you think medical device engineers and clinicians are unaware of the false alarm issue and haven't already tried a variety of improvements? There is an inherent trade-off between false alarms and missing a real problem. And devices need to be not only accurate but also affordable, durable, and cost effective. It's not easy to get this right.

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