Pediatric Informatics: Computer Applications in Child Health (Health ...

8 Complexity in Healthcare Information Technology Systems 91
performing optimally. Human Factors Engineering and its’ sub-field Ergonomics,
which deals with machine-related physical stresses on the human body, have never
been specifically studied for NICUs or PICUs. Thus, current knowledge is derived
from research in other venues that may have conceptual overlap with NICU and
PICU environments. Caution is warranted when extrapolating site-specific findings
to other “similar” environments. 26
NICUs and PICUs are complex environments with missions that are constantly
changing and evolving in real-time. Important ICU issues include the impact of
lighting and noise on human cognition, and the need to differentiate multiple
alarms with a response speed measured in seconds (Fig. 8.4). Many user interfaces
being applied in health care were designed for office or bench workers, not the ICU
caregivers. The law does not require that new medical equipment be tested in the
complex, multimachine environment with the intended users. Flaws in design are
thus often not recognized until the equipment is widely used. 6–8 Federal and state
pressure to computerize clinical healthcare quickly has resulted in installation and
use of software products that were not designed for intensive care environments
and have not been extensively tested in these venues. 27
8.2.3.2 Contribution of Health IT to Noise Pollution
Research of auditory alarms in complex environments such as power plants, airplanes,
and battle ships, has shown that most humans cannot reliably differentiate
more than six different, simultaneous auditory alarms. 26, 28 A NICU is a very noisy
environment, largely due to a cacophony of auditory alarms, not only from the eight
required monitor alarms, 19 but also from a variety of bedside medical devices with
individual alarms such as ventilators, warmers, and syringe pumps. Multisource
human speech, beepers, telephones, overhead paging, and local intercom conversations
all add to the noise level. Not only are patients and providers suffering from
generalized auditory overload, but also nursing staff are hampered in the difficult
task of identifying critical alarms from false alarms and background noise, and
responding efficiently and effectively.
Approximately 90% of the alarms are false in Pediatric critical care venues.
This means that despite a visual or auditory alarm that requires the attention of a
nurse, the patient is actually fine in the majority of events. Nevertheless, the provider
is expected to identify the source of the alarm, quickly assess the situation,
and take corrective action. Speed is essential, because the alarm may signal a true
life-threatening situation.
Measurements in NICUs have recorded transients noise levels to as high as
120–130 db. 29, 30 Decreasing auditory overload has become a primary design consideration
NICU and PICU renovations, mainly to reduce the noise associated stress
on neonates. Research on acoustic overload has shown that noise also has important
effects on human performance and cognition. 31 Long term exposure to constant noise
at levels that are common to a busy NICU (~85 + dB) can temporarily or permanently
deafen those exposed; even levels as low as 80 db “can have detrimental effects on
performance.” 31 Less cognitive information can be processed under continuous