Learning three sets of alarms for the same medical functions: A perspective on the difficulty of learning alarms specified in an international standard

Three sets of eight alarms supporting eight functions specified in an international medical equipment standard (IEC 60601-1-8) were tested for learnability using non-anaesthetist participants. One set consisted of the tonal alarms specified in the standard. A second set consisted of a set of abstract alarms randomly selected from a database of abstract alarm sounds held by the authors. A third set of alarms was designed as indirect metaphors of the functions. Participants were presented with the alarms and then asked to identify them across ten blocks of eight trials. The results indicated a significant difference in learnability across the three sets of alarms. The indirect metaphors were learned significantly better than both other sets of alarms, and the randomly selected abstract alarms were learned significantly better than the alarms specified in the standard. The results suggest therefore that there are more readily learnable possible designs than those proposed in the standard. The use of auditory icons in particular should be given serious consideration as potential alarms for this application.     

Learning medical alarms whilst performing other tasks

Two studies are reported which first observe, and then attempt to replicate, the cognitive demands of intensive care unit (ICU) activity whilst concurrently learning audible alarms. The first study, an observational study in an ICU ward, showed that the alarms are very frequent and co-occur with some activities more than others. The three most frequently observed activities observed in the ICU were drugs (calculation, preparation and administration), patient observation and talking. The cognitive demands of these activities were simulated in a second, laboratory-based experiment in which alarms were learned. The results showed that performance in the alarm task generally improved as participants were exposed to more repetitions of those alarms, but that performance decrements were observed in the secondary tasks, particularly when there were two or three of them. Some confusions between the alarms persisted to the end of the study despite prolonged exposure to the alarms, confusions which were likely caused by both acoustic and verbal labelling similarities.

Practitioner Summary: The cognitive demands of working in an ICU were observed and simulated whilst alarms were learned. Alarms should generally avoid sharing similar rhythmic (and other) characteristics. The simulation task described here could be used for testing alarm learning without requiring a clinical environment.     

Audibility and identification of auditory alarms in the operating room and intensive care unit

Abstract

The audibility and the identification of 23 auditory alarms in the intensive care unit (ICU) and 26 auditory alarms in the operating rooms (ORs) of a 214-bed Canadian teaching hospital were investigated. Digital tape recordings of the alarms were made and analysed using masked-threshold software developed at the Université de Montréal. The digital recordings were also presented to the hospital personnel responsible for monitoring these alarms on an individual basis in order to determine how many of the alarms they would be able to identify when they heard them. Several of the alarms in both areas of the hospital could mask other alarms in the same area, and many of the alarms in the operating rooms could be masked by the sound of a surgical saw or a surgical drill. The staff in the OR (anaesthetists, anaesthesia residents, and OR technologists) were able to identify a mean of between 10 and 15 of the 26 alarms found in their operating theatres. The ICU nurses were able to identify a mean of between 9 and 14 of the 23 alarms found in their ICU. Alarm importance was positively correlated with the frequency of alarm identification in the case of the OR, rho=0·411, but was not significantly correlated in the case of the ICU, rho=0·155. This study demonstrates the poor design of auditory warning signals in hospitals and the need for standardization of alarms on medical equipment.     

Nurses’ reactions to alarms in a neonatal intensive care unit

Neonatal intensive care units (NICUs), like other intensive care units, are intended to provide immediate responses to any change in the patients condition. Patient-monitoring alarms and alarms from other medical equipment are very common in these units, and most alarms have no clinical significance. This study addresses the question of how alarms affect nurses actions by measuring the occurrence of alarms from different causes in a NICU, recording the nurses reactions, and analyzing the relationship between the alarms and the actions. The results show that nurses often do not respond directly to alarms, but, rather, use them as additional sources of information in their ongoing flow of actions. The probabilities for their responding to an alarm depend on the causes of the alarm, its duration, and the characteristics of the patient. These findings support the view that experienced nurses dynamically adjust their activities according to the information they receive from alarm systems and other sources, and that they combine their reactive actions with the periodic performance of routine tasks.     

Operators׳ adaptation to imperfect automation – Impact of miss-prone alarm systems on attention allocation and performance

Operators in complex environments are often supported by alarm systems that indicate when to shift attention to certain tasks. As alarms are not perfectly reliable, operators have to select appropriate strategies of attention allocation to compensate for unreliability and to maintain overall performance. This study explores how humans adapt to differing alarm reliabilities. Within a multi-task simulation consisting of a monitoring task and two other concurrent tasks, participants were assigned to one of five groups. In the manual control group none of the tasks was supported by an alarm system, whereas the four experimental groups were supported in the monitoring task by a miss-prone alarm system differing in reliability, i.e. 68.75%, 75%, 87.5%, 93.75%. Compared to the manual control group, all experimental groups benefited from the support by alarms, with best performance for the highest reliability condition. However, for the lowest reliability group the benefit was associated with an increased attentional effort, a more demanding attention allocation strategy, and a declined relative performance in a concurrent task. Results are discussed in the context of recent automation research.     

Effects of single versus multiple warnings on driver performance

OBJECTIVE: To explore how a single master alarm system affects drivers' responses when compared with multiple, distinct warnings. BACKGROUND: Advanced driver warning systems are intended to improve safety, yet inappropriate integration may increase the complexity of driving, especially in high workload situations. This study investigated the effects of auditory alarm scheme, reliability, and collision event type on driver performance. METHOD: Using a 2 x 2 x 4 mixed factorial design, we investigated the impact of two alarm schemes (master vs. individual) and two levels of alarm reliability (high and low) on distracted drivers' performance across four collision event types (frontal collision warnings, left and right lane departure warnings, and warnings for a fast-approaching following vehicle). RESULTS: Participants' reaction times and accuracy rates were significantly affected by the type of collision event and alarm reliability. The use of individual alarms, rather than a single master alarm, did not significantly affect driving performance in terms of reaction time or response accuracy. CONCLUSION: Even though a master alarm is a relatively uninformative warning, it produced statistically no different reaction times or accuracy results when compared with information-rich auditory icons, some of which were spatially located. In addition, unreliable alarms negatively impacted driver performance, regardless of event type or alarm scheme. APPLICATION: These results have important implications for the development and implementation of multiple driver warning systems.     

Decision-making and response strategies in interaction with alarms: the impact of alarm reliability,availability of alarm validity information and workload

Responding to alarm systems which usually commit a number of false alarms and/or misses involves decision-making under uncertainty. Four laboratory experiments including a total of 256 participants were conducted to gain comprehensive insight into humans' dealing with this uncertainty. Specifically, it was investigated how responses to alarms/non-alarms are affected by the predictive validities of these events, and to what extent response strategies depend on whether or not the validity of alarms/non-alarms can be cross-checked against other data. Among others, the results suggest that, without cross-check possibility (experiment 1), low levels of predictive validity of alarms ( ≤ 0.5) led most participants to use one of two different strategies which both involved non-responding to a significant number of alarms (cry-wolf effect). Yet, providing access to alarm validity information reduced this effect dramatically (experiment 2). This latter result emerged independent of the effort needed for cross-checkings of alarms (experiment 3), but was affected by the workload imposed by concurrent tasks (experiment 4). Theoretical and practical consequences of these results for decision-making and response selection in interaction with alarm systems, as well as the design of effective alarm systems, are discussed.     

Slow eye movement as a possible predictor of reaction delays to auditory warning alarms in a drowsy state

In recently developed intelligent vehicles, warning alarms are often used to prompt avoidance behaviours from drivers facing imminent hazardous situations. However, when critical reaction delays to auditory stimulation are anticipated, the alarm should be activated earlier to compensate for such delays. It was found that reaction times to an auditory stimulus significantly increased in the presence of slow eye movement (SEM), which is known to occur frequently during the wake-sleep transition. The reaction delay could not be attributed to temporal effects such as fatigue and was invariant regardless of response effectors (finger or foot). Moreover, it was found that applied pedal force decreased immediately after an auditory stimulus interrupted SEM. Consequently, it was concluded that SEM can be a good predictor of reaction delays to auditory warning alarms when drivers are in a drowsy state. STATEMENT OF RELEVANCE: The present study demonstrated that simple auditory reaction time significantly increased when SEM emerged. In the design of vehicle safety systems using warning alarms to prompt avoidance behaviours from drivers, such reaction delays during SEM must be taken into account.     

Slow eye movement as a possible predictor of reaction delays to auditory warning alarms in a drowsy state

In recently developed intelligent vehicles, warning alarms are often used to prompt avoidance behaviours from drivers facing imminent hazardous situations. However, when critical reaction delays to auditory stimulation are anticipated, the alarm should be activated earlier to compensate for such delays. It was found that reaction times to an auditory stimulus significantly increased in the presence of slow eye movement (SEM), which is known to occur frequently during the wake–sleep transition. The reaction delay could not be attributed to temporal effects such as fatigue and was invariant regardless of response effectors (finger or foot). Moreover, it was found that applied pedal force decreased immediately after an auditory stimulus interrupted SEM. Consequently, it was concluded that SEM can be a good predictor of reaction delays to auditory warning alarms when drivers are in a drowsy state.

Statement of Relevance:The present study demonstrated that simple auditory reaction time significantly increased when SEM emerged. In the design of vehicle safety systems using warning alarms to prompt avoidance behaviours from drivers, such reaction delays during SEM must be taken into account.     

Heterogeneity in auditory alarm sets makes them easier to learn

The primary objective of the experiments reported here was to demonstrate the effects of opening up the design envelope for auditory alarms on the ability of people to learn the meanings of a set of alarms. Two sets of alarms were tested, one already extant and one newly-designed set for the same set of functions, designed according to a rationale set out by the authors aimed at increasing the heterogeneity of the alarm set and incorporating some well-established principles of alarm design. For both sets of alarms, a similarity-rating experiment was followed by a learning experiment. The results showed that the newly-designed set was judged to be more internally dissimilar, and easier to learn, than the extant set. The design rationale outlined in the paper is useful for design purposes in a variety of practical domains and shows how alarm designers, even at a relatively late stage in the design process, can improve the efficacy of an alarm set.     

An investigation of training strategies to improve alarm reactions

Researchers have suggested that operator training may improve operator reactions; however, researchers have not documented this for alarm reactions. The goal of this research was to train participants to react to alarms using sensor activity patterns. In Experiment 1, 80 undergraduates monitored a simulated security screen while completing a primary word search task. They received spatial, temporal, single sensor, or no training to respond to alarms of differing reliability levels. Analyses revealed more appropriate and quicker reactions when participants were trained and when the alarms were reliable. In Experiment 2, 56 participants practiced time estimation by simple repetition, performance feedback, or performance feedback and temporal subdivision. They then reacted to alarms based on elapsed time between sensor activity and alarm onset. Surprisingly, results indicated that participants did not benefit differentially from temporal interval training, focusing instead on advertised system reliability. Researchers should replicate these findings with realistic tasks and real-world complex task operators.     

Semantic congruency of auditory warnings

Abstract

The aim of this study was to explore operator experience and performance for semantically congruent and incongruent auditory icons and abstract alarm sounds. It was expected that performance advantages for congruent sounds would be present initially but would reduce over time for both alarm types. Twenty-four participants (12M/12F) were placed into auditory icon or abstract alarm groupings. For each group both congruent and incongruent alarms were used to represent different driving task scenarios. Once sounded, participants were required to respond to each alarm by selecting a corresponding driving scenario. User performance for all sound types improved over time, however even with experience a decrement in speed of response remained for the incongruent iconic sounds and in accuracy of performance for the abstract warning sounds when compared to the congruent auditory icons. Semantic congruency was found to be of more importance for auditory icons than for abstract sounds.

Practitioner Summary: Alarms are used in many operating systems as emergency, alerting, or continuous monitoring signals for instance. This study found that the type and representativeness of an auditory warning will influence operator performance over time. Semantically congruent iconic sounds produced performance advantages over both incongruent iconic sounds and abstract warnings.     

一种新的告警关联聚类算法

针对网络中的告警泛洪和故障处理复杂问题, 提出一种结合元胞学习自动机(CLA)和决策树ID3的新告警关联聚类算法。在CLA算法中使用学习自动机对告警信号进行分簇, 但是在一个簇内如果出现任何子群或交错, 则决策树ID3学习算法通过分割数据样本训练在该簇上来优化决策边界, 从而大大减少分簇告警数目以及完成对根源性告警的定位。仿真表明, 该算法能有效地对大量告警信号进行分析, 并且能比较准确地鉴定出根源性告警。     

Alarm mistrust in automobiles: how collision alarm reliability affects driving

As roadways become more congested, there is greater potential for automobile accidents and incidents. To improve roadway safety, automobile manufacturers are now designing and incorporating collision avoidance warning systems; yet, there has been little investigation of how the reliability of alarm signals might impact driver performance. We measured driving and alarm reaction performances following alarms of various reliability levels. In Experiment One, 70 participants operated a driving simulator while being presented console emitted collision alarms that were 50%, 75%, or 100% reliable. In Experiment Two, the same participants were presented spatially generated collision alarms of the same reliability levels. The results were similar in both experiments: alarm and automobile swerving reactions were significantly better when alarms were more reliable; however, drivers still failed to avoid collisions following reliable alarms. These results emphasize that alarm designers should maximize alarm reliability while minimizing alarm invasiveness.     

Alarm-initiated activities: an analysis of alarm handlingby operators using text-based alarm systems in supervisory control systems

Alarms constitute a significant aspect of the operator-system interface in human supervisory control tasks: they have the potential to display information that is of critical importance to overall system safety and integrity. This paper considers the trend toward the use of visual display terminals for the presentation of alarms, specifically in the use of scrolling text displays. It is suggested that this form of information display may not best serve all aspects of alarm handling. To illustrate why this is so, an analysis of human alarm handling activities is presented. The focus on text-based displays and annunciators allows the authors to concentrate on a number of problems associated with the alarm design using a specific medium. From this discussion, the alarm initiated activities model is developed. By considering the activities that people engage in when dealing with alarms, an insight is offered into the information requirements that can be used to inform the design of alarm systems.     

Behavioural implications of alarm mistrust as a function of task workload

The research was conducted to investigate the effect of increasing primary task and alarm workload on alarm mistrust as reflected by alarm and primary task performances. A total of 126 undergraduate students performed a complex psychomotor task battery three times, with the number of concurrent tasks increasing each time. During their performance, the students were required to react to an alarm system (including visual and auditory components) of questionable reliability. Depending on the group to which participants were assigned, the alarm presentation rate constituted a low-, medium- or high-workload condition. Alarm response data (times, frequencies, accuracies) and primary task data (tracking error) were analyzed to assess performance differences as a function of primary and secondary task workload levels. Results generally supported the hypotheses: increasing primary task and alarm task workload degraded alarm response performance. Also, response frequencies supported earlier research suggesting that participants 'probability match' their response rates to alarm system reliability. The results are discussed with regard to the cry-wolf effect, attention theory and alarm system design.     

Behavioural implications of alarm mistrust as a function of task workload

The research was conducted to investigate the effect of increasing primary task and alarm workload on alarm mistrust as reflected by alarm and primary task performances. A total of 126 undergraduate students performed a complex psychomotor task battery three times, with the number of concurrent tasks increasing each time. During their performance, the students were required to react to an alarm system (including visual and auditory components) of questionable reliability. Depending on the group to which participants were assigned, the alarm presentation rate constituted a low-, medium- or highworkload condition. Alarm response data (times, frequencies, accuracies) and primary task data (tracking error) were analyzed to assess performance differences as a function of primary and secondary task workload levels. Results generally supported the hypotheses: increasing primary task and alarm task workload degraded alarm response performance. Also, response frequencies supported earlier research suggesting that participants ‘probability match’ their response rates to alarm system reliability. The results are discussed with regard to the cry-wolf effect, attention theory and alarm system design.     

A combined analysis of plant connectivity and alarm logs to reduce the number of alerts in an automation system

A process alarm arises when normal operation limits are exceeded and an alarm management system alerts the operator of a process plant. Due to the material, energy and information flow in a plant, single disturbances can cause multiple consequent alarm messages, and the alarm messages may overload the operator by presenting many redundant alarms. This undesired situation is called an ‘alarm flood’. In such situations, the operator might not be able to fulfil his required tasks to keep the plant within safe operation limits and to find the root cause of the disturbance. The aim of the work presented in this paper is to reduce the number of alerts presented to the operator. If alarms are related to one another, those alarms should be grouped and presented as one alarm problem. For the implementation of the concept, a software prototype has been developed to perform this reduction automatically. The analysis process starts with the alarm history which is a log containing all past alarm messages. This is combined with the plant topology of the controlled system and a set of rules. The rules describe typical interrelations between alarm messages which have a common cause. The combination of these three elements yields an effective alarm management strategy that can help plant owners and operators to comply with standards for alarm management such as ANSI/ISA 18.2 (2009) and EEMUA 191 (2007) which set limits on the number of alarms per unit time for an operator. The effectiveness of the approach is illustrated by two industrial examples where a significant reduction of alarms has been achieved.     

Human probability matching behaviour in response to alarms of varying reliability

The goals of this research were to substantiate the existence of the cry-wolf effect for alarm responses, quantifying its effect on operator performance. A total of 138 undergraduate students performed two blocks of a cognitively demanding psychomotor primary task; at the same time, they were presented with alarms of varying reliabilities (25, 50 and 75% true alarms) and urgencies (green, yellow and red visual alarms presented concurrently with low-, medium- and high-urgency auditory civilian aircraft cockpit alarms). Alarm response frequencies were observed and analysed, and /-tests and repeated-measures MANOVAs were used to assess the effects of increasing alarm reliability on alarm response frequencies, speed and accuracy. The results indicate that most subjects (about 90%) do not respond 10 all alarms but match their response rates to the expected probability of true alarms (probability matching). About 10% of the subjects responded in the extreme, utilizing an all-or-none strategy. Implications of these results for alarm design instruction and further research are discussed.     

The influence of alarm timing on driver response to collision warning systems following system failure

This driving simulator study focuses on false and missing alarms produced by a forward collision warning system and estimates the effect of alarm timing on driver response to alarm malfunction from the perspective of driver trust in alarms. The results show that drivers who experience late alarms are reluctant to respond to a false alarm and are not influenced by a missed alarm; however, drivers who experience early alarms tend to respond to a false alarm and suffer a delayed response to critical situations when a missing alarm happens. Furthermore, drivers whose judgement of trust is relatively high, tend to exhibit delayed braking, compared with drivers that have lower levels of trust. Driver behaviour towards false and missed alarms may vary according to alarm timing and its influence on trust in alarms; moreover, impaired system effectiveness caused by alarm malfunction may be mitigated by manipulating alarm timing.