Human judgment is better: Patient advocates and fatigue alarm

Liz Kowalczyk's recent articles in the Boston Globe highlighted the problem of alarm fatigue in Massachusetts hospitals. The noisy alarms are so often false alarms that staff learn to ignore them. Since most of the alarms are false alarms, ignoring them is usually harmless. But sometimes, of course, the alarms are genuine. One set of disregarded alarms led to the death of Madeline Warner in a Massachusetts hospital. Alarms had sounded for 75 minutes, warning that her heart monitor's battery needed to be replaced. Kowalczyk found that hundreds of deaths had been causes by such alarm fatigue in the last five years; indeed, this probably represents only the tip of an iceberg.

"If there were an obvious solution to this problem, we would have done’" it, said Dr. James Bagian, the former chief patient safety officer for the Veterans Administration hospitals, where he said there have been multiple patient deaths and close calls because alarms were turned off or the volume was turned down. "No one has one."

I disagree. There may well not be a technical solution now, given the current state of technology. Human judgment is better. But most humans in hospitals are busy taking care of numerous patients. A dedicated patient advocate, on the other hand, is focused on a single patient. When family members acting as advocates, or professional patient advocates, insist on a Rapid Response by hospital staff, for example, in a de facto humanly-triggered alarm, about half the Rapid Responses are later ascertained as valid, with the benefit of hindsight. That true positive rate of 50% is far higher than the true positive rate of machine alarms. That is one of the most powerful reasons why people should bring a patient advocate, preferably a professional, into the hospital with them.

Advice to hospitalized patients: Bring a patient advocate with you.

Read another story on hospital Rapid Response methods.

If you have a family member in the hospital: Rapid Response methods

Our Rapid Response Work Group of the Consumer Health Quality Council of Health Care for All will encourage insurers in Massachusetts to publicize an important message to their members throughout Massachusetts. We hope they'll tell people how they can call for a Rapid Response method or team in the hospital, if needed, to rescue a family member whose health is suddenly deteriorating in the hospital. We hope they'll include it in their print and e-newsletters and emails to their members.

The announcement will alert people that certain warning signs often precede, by several hours, a usually fatal heart attack or respiratory arrest in the hospital. "Failure to rescue" is one of the most common causes of in-hospital deaths, so this could save many people's lives.

The announcement reads like this:

Have a Family Member in the Hospital?



Be aware that certain signs can warn that a heart attack or respiratory arrest can occur in the next few hours:

A sustained noticeable change, either an increase or decrease, in their:

Breathing rate;

Heart rate or Pulse; or

Blood pressure;


Or if they experience Confusion.



You can ask the nurse about the specific criteria your hospital uses.

If you see that your loved one is experiencing one or more of these signs while in the hospital, you can insist that the hospital respond promptly with a "Rapid Response Method" or a "Rapid Response Team." That's a new state law (Chapter 305 of Massachusetts General Laws), and is required by the hospital's accrediting body, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).


Non-Massachusetts residents should realize that you, too, can call for a Rapid Response, per the JCAHO regulations, even if you don't have a state law requiring it.

Read another story about rapid response teams.