Correlations between monitor alarm workload and overall workload in Swedish emergency departments: a prospective...

Emergency department staff work under substantial and variable demands. Physiologic monitoring is an integral part of the ED working environment and supports the observation of several patients at the same time, but the alarms generated by monitoring equipment may also add to staff workload. We examined the relation between perceived alarm workload and overall workload and assessed whether operational factors were associated with alarm workload after adjustment for overall workload.

We conducted a prospective, multicenter, cross sectional study at three Swedish emergency departments. During clinical shifts, staff rated their overall workload and alarm workload during the preceding hour on a scale from 0 to 6. Survey responses were matched by emergency department team and hour with patient data from electronic health records and alarm data from monitoring systems. Pearson correlation was used to assess the relation between the two workload measures. Multivariable linear regression was used to examine associations between alarm workload and prespecified operational variables.

A total of 184 surveys covering 81 h were collected. Alarm workload was moderately correlated with overall workload r = 0.53, with P < 0.001. After observations without patients were excluded, 68 h were included in the regression analysis. Overall workload, the proportion of patients arriving by ambulance, and the frequency of technical alarms were associated with greater alarm workload in the adjusted analysis. Monitoring equipment was considered helpful in 68% of assessments and disruptive in 18%.

Perceived alarm workload was moderately correlated with overall workload. A higher proportion of patients arriving by ambulance and a higher frequency of technical alarms were associated with greater alarm workload after adjustment for overall workload. These findings may help guide efforts to reduce the workload associated with monitor alarms in emergency departments.