Organizing Audible Alarm Sounds in the Hospital: A Card-Sorting Study

In hospitals, clinicians are presented with varied and disorganized alarm sounds from disparate devices. While there has been attention to reducing inactionable alarms to address alarm overload, little effort has focused on organizing, simplifying, or improving the informativeness of alarms. We sought to elicit nurses' tacit interpretation of alarm events to create an organizational structure to inform the design of advanced alarm sounds or integrated alert systems. We used open card sorting to evaluate nurses' perception of the relatedness of different alarm events. Seventy hospital nurses sorted 89 alarm events into groups they believed could or should be indicated by the same sound. We conducted factor analysis on a similarity matrix of frequency of alarm event pairings to interpret how strongly alarm events loaded on different alarm groups (factors). We interpreted participants' grouping rationale from their group labels and comments. Urgency of response was the most common grouping rationale. Participants also grouped: 1) monitoring-related events, 2) device-related events, and 3) events related to calls and patients. Our findings support standardization and integration of alarm sounds across devices toward a simpler and more informative hospital alarm environment.