Hospital alarms, going off around the clock

“Maria Cvach, an alarm expert and director of policy management and integration for Johns Hopkins Health System, found that on one step-down unit (a level below intensive care) in the hospital in 2006, an average of 350 alarms went off per patient per day—from the cardiac monitor alone….

“Bed alarms have proliferated since 2008 when the Centers for Medicare and Medicaid Services declared hospital falls should ‘never’ happen and stopped paying for injuries related to those falls. After that policy change, the odds of nurses using a bed alarm increased 2.3 times, according to a study led by Dr. Ronald Shorr, director of the Geriatric Research, Education and Clinical Center at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Fla. The alarms have become a standard feature in new hospital beds.” Meanwhile, in 2017 the same federal agency “began discouraging their widespread use in nursing homes, arguing that audible bed or chair alarms may be considered a ‘restraint’ if the resident ‘is afraid to move to avoid setting off the alarm.'” [Melissa Bailey, Kaiser Health News via Virginia Postrel; earlier here, here, and here]


  • I spent 10 days in the neurological ICU last year. It was miserable, not only because of the staples in my head following the removal of a brain tumor, but because I was being chastised every time I moved. The bed alarms were calibrated to be so incredibly sensitive that merely adjusting my position in the bed could cause it to go off. I understand the need for alarms for patients who, like me, were considered a falling risk. However, does it really benefit the patient to make them so afraid of the alarm (and the subsequent pain loud noises can cause someone recovering from brain surgery) that they are too afraid to move?

  • The number 350 alarms per patient per day is absurd. That is 14 times per hour or once every 4 minutes.
    However, the point is valid that alarms are excessive. When I was in for heart attack (US), the open door with light coming in and alarms for even the IV bag being empty made sleep very difficult–sleep is critical for healing. I also found that when an alarm did go off the nurse response was NOT immediate.

  • Hair-trigger alarms are the wrong solution for the problem. It is well known that repeated false alarms results in the alarm being ignored, and the condition that the alarm was meant to address goes unnoticed.

    The problem is that the collective nursing staff (RNs, LPNs, CNAs, etc.) in hospitals and other medical care facilities are not attentive to patients’ needs for reasons ranging from being spread too thin among the many patients they have, to outright apathy. It is well known among medical professionals, that hospitalized or other frail patients think that they can walk without falling, when they cannot. When a patient presses the call bell for assistance in going to the bathroom, and no one answers for a half-hour, the patient does the natural thing, and tries to ambulate himself. Often, this results in a fall, especially in the elderly, with grave consequences such as a broken hip.

    The Center for Medicare Services therefore added hospital falls to their list of “never events” (serious, PREVENTABLE, and costly medical errors) whereby CMS will not reimburse a hospital for care related to an injury due to a fall.
    Other items on the list of “never events” include operating on the wrong site or wrong patient or performing the wrong procedure on the patient, delivering a gas other than oxygen to a patient, when oxygen was intended, burns to a patient, delivering an infant on discharge to the wrong person, etc.

    The bottom line is that patient falls are indeed preventable at a small fraction of the cost than to treat the resulting patient injuries, and preventing them is the absolute duty of the medical care facility. How a care facility wants to do so is their prerogative. They can hire someone that frequently circulates among the patients to ensure that they are not getting out of bed unassisted. They can install accurate bed alarms and actually monitor those alarms. If they chose to install ultra-sensitive alarms that go off all the time, and no one responds, and a patient falls, that is their negligence, not the patient’s, and the hospital has to face the consequences. If they chose to do nothing, and a patient falls, that is their negligence and they have to face the consequences. If they chose to pray to the guardian saint of healthcare, and a patient falls, that is their negligence….

    Many facilities find patients that have fallen, and put them back into bed with the injury from the fall, and fail to document anything it in the chart, and many facilities fail to report falls and other reportable injuries as part of the mandatory reporting system for a variety of reasons, including fear of losing Medicare or insurance payments.

    Hospitals, in general, run sloppy ships, and the norm is not acceptable. If the hospital cannot eliminate the “preventable” events that is their fault, and they deserve not to get paid for the patient’s injuries. It therefore behooves all medical care facilities to properly address this problem.

  • Rumor is that medical mistakes are the third leading cause of death in this country, behind heart disease and cancer. And the medical trade knows it. Alarms are an easy sell.
    Nextgen tech will have a learning-enabled hierarchical algorithm to monitor each patient, treatment, and alarm pattern. Think Dr. Alexa directing staff. If it saves 1,000 or 2,000 lives a year it’s a good investment. Dr. McCoy can go explore the joys of low-gravity golf.