{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T16:52:49Z","timestamp":1762102369420,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T00:00:00Z","timestamp":1552089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["16SV7501"],"award-info":[{"award-number":["16SV7501"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MTI"],"abstract":"<jats:p>Technology plays a prominent role in intensive care units (ICU), with a variety of sensors monitoring both patients and devices. A serious problem exists, however, that can reduce the sensors\u2019 effectiveness. When important values exceed or fall below a certain threshold or sensors lose their signal, up to 350 alarms per patient a day are issued. These frequent alarms are audible in several locations on the ICU, resulting in a massive cognitive load for ICU nurses, as they must evaluate and acknowledge each alarm. \u201cAlarm fatigue\u201d sets in, a desensitization and delayed response time for alarms that can have severe consequences for patients and nurses. To counteract the acoustic load on ICUs, we designed and evaluated personal multimodal alarms for a wearable alarm system (WAS). The result was a lower response time and higher ratings on suitability and feasibility, as well as a lower annoyance level, compared to acoustic alarms. We find that multimodal alarms are a promising new approach to alert ICU nurses, reduce cognitive load, and avoid alarm fatigue.<\/jats:p>","DOI":"10.3390\/mti3010015","type":"journal-article","created":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T03:49:31Z","timestamp":1552362571000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["To Beep or Not to Beep? Evaluating Modalities for Multimodal ICU Alarms"],"prefix":"10.3390","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4690-0800","authenticated-orcid":false,"given":"Vanessa","family":"Cobus","sequence":"first","affiliation":[{"name":"OFFIS\u2014Institute for IT, Escherweg 2, 26122 Oldenburg, Germany"}]},{"given":"Wilko","family":"Heuten","sequence":"additional","affiliation":[{"name":"OFFIS\u2014Institute for IT, Escherweg 2, 26122 Oldenburg, Germany"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/ACO.0000000000000260","article-title":"Alarm fatigue: Impacts on patient safety","volume":"28","author":"Ruskin","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1213\/ane.0b013e3181606927","article-title":"\u201cFor if the trumpet give an uncertain sound, who shall prepare himself to the battle?\u201d (I Corinthians 14:8, KJV)","volume":"106","author":"Block","year":"2008","journal-title":"Anesth. Analgesia"},{"key":"ref_3","first-page":"591","article-title":"Too many abandon the \u201csecond victims\u201d of medical errors","volume":"39","author":"Grissinger","year":"2014","journal-title":"P&T"},{"key":"ref_4","first-page":"107","article-title":"Alarm fatigue: causes and effects","volume":"243","author":"Wilken","year":"2017","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/CCM.0000000000002803","article-title":"Technological Distractions (Part 2): A Summary of Approaches to Manage Clinical Alarms With Intent to Reduce Alarm Fatigue","volume":"46","author":"Winters","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Altosaar, M., Vertegaal, R., Sohn, C., and Cheng, D. (2006, January 20\u201324). AuraOrb: Using social awareness cues in the design of progressive notification appliances. Proceedings of the 18th Australia Conference on Computer-Human Interaction: Design: Activities, Artefacts and Environments, Sydney, Australia.","DOI":"10.1145\/1228175.1228204"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1055\/s-2006-941455","article-title":"A noise-sensor light alarm reduces noise in the newborn intensive care unit","volume":"23","author":"Chang","year":"2006","journal-title":"Am. J. Perinatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Lee, S.C., and Starner, T. (2010, January 10\u201315). BuzzWear: Alert perception in wearable tactile displays on the wrist. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, Atlanta, GA, USA.","DOI":"10.1145\/1753326.1753392"},{"key":"ref_9","unstructured":"Cobus, V., Boll, S., and Heuten, W. (2018). Requirements for a Wearable Alarm Distribution System in Intensive Care Units. Zukunft der Pflege, Tagungsband der 1. Clusterkonferenz 2018\u2014Innovative Technologien f\u00fcr die Pflege. oops, BIS-Verlag."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Cobus, V., Ehrhardt, B., Boll, S., and Heuten, W. (2018, January 6\u20138). Vibrotactile Alarm Display for Critical Care. Proceedings of the 7th ACM International Symposium on Pervasive Displays, Munich, Germany.","DOI":"10.1145\/3205873.3205886"},{"key":"ref_11","unstructured":"Cobus, V., Meyer, H., Boll, S., and Heuten, W. (October, January 29). Towards Reducing Alarm Fatigue: Peripheral Light Pattern Design for Critical Care Alarms. Proceedings of the 10th Nordic Conference on Human-Computer Interaction, Oslo, Norway."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1518\/001872008X288394","article-title":"Multiple resources and mental workload","volume":"50","author":"Wickens","year":"2008","journal-title":"Hum. Fact."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/NCQ.0b013e3182a61887","article-title":"Use of pagers with an alarm escalation system to reduce cardiac monitor alarm signals","volume":"29","author":"Cvach","year":"2014","journal-title":"J. Nurs. Care Qual."},{"key":"ref_14","unstructured":"Brander, S., and von Schewen Sterndal, K. (2014). Development of Wearable Healthcare Device: A User-Centred Project Focused on Meeting Discovered Needs of Nurses. [Master\u2019s Thesis, Machine Design (Dept.), KTH]."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1007\/BF00249795","article-title":"Sensory perception during movement in man","volume":"68","author":"Chapman","year":"1987","journal-title":"Exp. Brain Res."},{"key":"ref_16","first-page":"31","article-title":"The use of smart glasses in healthcare\u2014Review","volume":"3","author":"Wrzesinska","year":"2015","journal-title":"MEDtube Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.ijsu.2014.09.014","article-title":"Medical applications of near-eye display devices: An exploratory study","volume":"12","author":"Vorraber","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1515\/cdbme-2015-0127","article-title":"Use cases and usability challenges for head-mounted displays in healthcare","volume":"1","author":"Mentler","year":"2015","journal-title":"Curr. Direct. Biomed. Eng."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pascale, M.T., Sanderson, P., Liu, D., Mohamed, I., Brecknell, B., and Loeb, R.G. (2019). The Impact of Head-Worn Displays on Strategic Alarm Management and Situation Awareness. Hum. Fact.","DOI":"10.1177\/0018720818814969"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1213\/01.ANE.0000184121.03150.62","article-title":"An evaluation of a vibro-tactile display prototype for physiological monitoring","volume":"101","author":"Ng","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1109\/LRA.2016.2528295","article-title":"Multiactuator haptic feedback on the wrist for needle steering guidance in brachytherapy","volume":"1","author":"Rossa","year":"2016","journal-title":"IEEE Robot. Autom. Lett."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1177\/1541931214581158","article-title":"Tactile displays of pulse oximetry in integrated and separated configurations","volume":"Volume 58","author":"McLanders","year":"2014","journal-title":"Proceedings of the Human Factors and Ergonomics Society Annual Meeting"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1213\/ANE.0b013e31825d638c","article-title":"A vibro-tactile display for clinical monitoring: Real-time evaluation","volume":"115","author":"Dosani","year":"2012","journal-title":"Anesth. Analg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Fortmann, J., Cobus, V., Heuten, W., and Boll, S. (2014, January 25\u201328). WaterJewel: Design and Evaluation of a Bracelet to Promote a Better Drinking Behaviour. Proceedings of the 13th International Conferernce on Mobile and Ubiquitous Multimedia, Melbourne, Australia.","DOI":"10.1145\/2677972.2677976"},{"key":"ref_25","unstructured":"Matviienko, A., Cobus, V., M\u00fcller, H., Fortmann, J., L\u00f6cken, A., Boll, S., Rauschenberger, M., Timmermann, J., Trappe, C., and Heuten, W. (December, January 30). Deriving Design Guidelines for Ambient Light Systems. Proceedings of the 14th International Conferernce on Mobile and Ubiquitous Multimedia, Linz, Austria."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/01.mao.0000187236.10842.d5","article-title":"Bone-conducted sound: Physiological and clinical aspects","volume":"26","author":"Stenfelt","year":"2005","journal-title":"Otol. Neurotol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1080\/00140130701747509","article-title":"Bone conduction reception: Head sensitivity mapping","volume":"51","author":"McBride","year":"2008","journal-title":"Ergonomics"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Myles, K., and Kalb, J.T. (2010). Guidelines for Head Tactile Communication, Army Research Lab Aberdeen. Technical Report.","DOI":"10.21236\/ADA519112"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1080\/15298868.2012.718865","article-title":"Too exhausted for operation? Anxiety, depleted self-control strength, and perceptual\u2014Motor performance","volume":"12","author":"Englert","year":"2013","journal-title":"Self Identity"},{"key":"ref_30","unstructured":"Yadunath, R.V., and Jeyapaul, R. (2019, January 25). Trip-Hit Accidents and Safety: Human Error Psychology and Influence of the Subconscious Mind in Preventing and Causing Trip Hit Accidents. Available online: http:\/\/inet.vidyasagar.ac.in:8080\/jspui\/bitstream\/123456789\/250\/1\/42.Trip-Hit."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1080\/19488300.2011.609524","article-title":"Measuring workload of ICU nurses with a questionnaire survey: The NASA Task Load Index (TLX)","volume":"1","author":"Hoonakker","year":"2011","journal-title":"IIE Trans. Healthc. Syst. Eng."},{"key":"ref_32","first-page":"4","article-title":"SUS-A quick and dirty usability scale","volume":"189","author":"Brooke","year":"1996","journal-title":"Usabil. Eval. Ind."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1518\/0018720053653875","article-title":"A tool to assess the comfort of wearable computers","volume":"47","author":"Knight","year":"2005","journal-title":"Hum. Fact."}],"container-title":["Multimodal Technologies and Interaction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-4088\/3\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:37:39Z","timestamp":1760186259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-4088\/3\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,9]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,3]]}},"alternative-id":["mti3010015"],"URL":"https:\/\/doi.org\/10.3390\/mti3010015","relation":{},"ISSN":["2414-4088"],"issn-type":[{"type":"electronic","value":"2414-4088"}],"subject":[],"published":{"date-parts":[[2019,3,9]]}}}