Capturing the attentional response to clinical auditory alarms: An ERP study on priority pulses.

Ferreira, Vasco Ribeiro; Pereira, Ana Rita; Vieira, Joana; Pereira, Frederico; Marques, Rui; Campos, Guilherme; Sampaio, Adriana; Crego, Alberto · 2023 · DOAJ

DOI: 10.1371/journal.pone.0281680

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Summary

This study investigates the neurophysiological and behavioral effectiveness of auditory alarm priority pulses defined in the updated IEC 60601-1-8:2020 standard. Clinical environments are characterized by high levels of auditory noise, which can mask critical alarms and compromise patient safety. While the 2020 standard replaced previous mnemonic alarm designs with auditory icons and specific priority pointers to convey urgency, prior research indicated that earlier standards failed to effectively distinguish between medium and high priority levels. This research aims to determine whether the new priority pulses successfully capture attention and convey urgency by measuring brain responses and reaction times in a simulated hospital soundscape. The researchers employed a mixed-methods approach involving electroencephalography (EEG) and behavioral testing. For the electrophysiological experiment, 29 healthy adults participated in an oddball paradigm where they listened to a sequence of frequent generic SpO2 beeps (representing background hospital noise) interspersed with infrequent deviant stimuli: either Medium Priority (MP) or High Priority (HP) pulses. Participants were instructed to ignore the sounds and watch a muted video, allowing for the measurement of pre-attentive brain processing. The study focused on two Event-Related Potential (ERP) components: the Mismatch Negativity (MMN), which reflects automatic detection of auditory changes, and the P3a, which indicates attentional capture. A separate behavioral experiment involved 27 participants who actively responded to MP and HP pulses (and full-length bursts) by pressing keys as quickly as possible, measuring reaction times and accuracy. Contrary to the study’s hypothesis, the results indicated that the Medium Priority pulse elicited a larger MMN and P3a peak amplitude than the High Priority pulse. This suggests that, within the tested soundscape, the MP pulse was more easily detected and captured attention at the neural level than the HP pulse. Behavioral data supported these electrophysiological findings, showing significantly shorter reaction times for the Medium Priority pulse compared to the High Priority pulse. These findings imply that the current design of the priority pointers in the IEC 60601-1-8:2020 standard may not be successfully conveying the intended hierarchy of urgency. The inefficacy appears to stem from both the acoustic design properties of the pulses and their interaction with the surrounding hospital soundscape. The significance of this study lies in its demonstration that standardized alarm designs do not automatically ensure effective communication of urgency. The discrepancy between the intended priority levels and the actual neural and behavioral responses highlights a critical flaw in the current standard’s implementation. The authors conclude that there is an urgent need for intervention in both hospital soundscape management and the acoustic design of auditory alarms. Future alarm design must account for how sounds are processed in noisy environments and ensure that priority indicators are distinguishable and effective in capturing clinical staff attention to prevent safety hazards.

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• auditory warnings