Psychological Neuroscience Laboratory (PNL), Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal.
Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, Netherlands.
PLoS One. 2023 Feb 16;18(2):e0281680. doi: 10.1371/journal.pone.0281680. eCollection 2023.
Clinical auditory alarms are often found in hospital wards and operating rooms. In these environments, regular daily tasks can result in having a multitude of concurrent sounds (from staff and patients, building systems, carts, cleaning devices, and importantly, patient monitoring devices) which easily amount to a prevalent cacophony. The negative impact of this soundscape on staff and patients' health and well-being, as well as in their performance, demand for accordingly designed sound alarms. The recently updated IEC60601-1-8 standard, in guidance for medical equipment auditory alarms, proposed a set of pointers to distinctly convey medium or high levels of priority (urgency). However, conveying priority without compromising other features, such as ease of learnability and detectability, is an ongoing challenge. Electroencephalography, a non-invasive technique for measuring the brain response to a given stimulus, suggests that certain Event-Related Potentials (ERPs) components such as the Mismatch Negativity (MMN) and P3a may be the key to uncovering how sounds are processed at the pre-attentional level and how they may capture our attention. In this study, the brain dynamics in response to the priority pulses of the updated IEC60601-1-8 standard was studied via ERPs (MMN and P3a), for a soundscape characterised by the repetition of a sound (generic SpO2 "beep"), usually present in operating and recovery rooms. Additional behavioural experiments assessed the behavioural response to these priority pulses. Results showed that the Medium Priority pulse elicits a larger MMN and P3a peak amplitude when compared to the High Priority pulse. This suggests that, at least for the applied soundscape, the Medium Priority pulse is more easily detected and attended at the neural level. Behavioural data supports this indication, showing significantly shorter reaction times for the Medium Priority pulse. The results pose the possibility that priority pointers of the updated IEC60601-1-8 standard may not be successfully conveying their intended priority levels, which may not only be due to design properties but also to the soundscape in which these clinical alarms are deployed. This study highlights the need for intervention in both hospital soundscapes and auditory alarm design settings.
临床听觉警报器通常在医院病房和手术室中使用。在这些环境中，日常的常规任务可能会导致同时出现多种声音（来自工作人员和患者、建筑系统、手推车、清洁设备，以及重要的是，患者监护设备），这很容易造成嘈杂的声音环境。这种声音环境对工作人员和患者的健康和福祉以及他们的表现产生负面影响，因此需要设计相应的声音警报器。最近更新的 IEC60601-1-8 标准为医疗设备听觉警报器提供了指导，提出了一组指针，以清晰地传达中等到高优先级（紧急）水平。然而，在不影响其他特征（如易学性和可检测性）的情况下传达优先级仍然是一个持续的挑战。脑电图是一种测量大脑对给定刺激反应的非侵入性技术，表明某些事件相关电位（ERPs）成分，如失匹配负波（MMN）和 P3a，可能是揭示声音在非注意水平上如何被处理以及它们如何吸引我们注意力的关键。在这项研究中，通过 ERPs（MMN 和 P3a）研究了对更新的 IEC60601-1-8 标准的优先级脉冲的大脑动态，该声音环境的特征是重复一个声音（通常在手术室和恢复室中出现的通用 SpO2“哔哔”声）。额外的行为实验评估了对这些优先级脉冲的行为反应。结果表明，与高优先级脉冲相比，中优先级脉冲会引起更大的 MMN 和 P3a 峰值幅度。这表明，至少对于应用的声音环境，中优先级脉冲在神经水平上更容易被检测和注意。行为数据支持这一指示，表明中优先级脉冲的反应时间明显更短。研究结果表明，更新的 IEC60601-1-8 标准的优先级指针可能无法成功传达其预期的优先级水平，这不仅可能是由于设计特性，还可能是由于这些临床警报部署的声音环境。这项研究强调了需要干预医院声音环境和听觉警报设计设置。
