Alarm fatigue in healthcare: a scoping review of definitions, influencing factors, and mitigation strategies

Abstract

Background: Alarm Fatigue is recognized as a significant risk to both patient safety and the well-being of healthcare professionals (HCPs). However, it remains an underexplored phenomenon, further complicated by the lack of a harmonized definition. This review aims to (1) propose a harmonized definition; (2) identify operationalization methods; (3) summarize influencing factors; (4) examine consequences; and (5) outline potential strategies for reducing Alarm Fatigue.

Methods: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic search was conducted in PubMed, CINAHL, MEDLINE, and Google Scholar using keywords related to Alarm Fatigue, covering the literature published up to April 2024. Publications were included if they addressed at least one of the five review objectives. Extracted data covered definitions, operationalization methods, influencing factors, consequences, and mitigation strategies.

Results: A total of 32 publications were included. Definitions varied, but most described Alarm Fatigue as a phenomenon in which repeated exposure to frequent or non-actionable alarms leads to sensory overload, emotional strain, and a gradual desensitization or reduced responsiveness among HCPs, increasing the risk of delayed or inadequate alarm responses and compromising patient safety. Self-report questionnaires and observational methods were most frequently used tools for operationalization, while physiological and lab-based approaches were rare. Alarm overload, psychosocial work conditions, and individual traits have been identified as factors that may increase the likelihood of Alarm Fatigue. In turn, Alarm Fatigue was linked to delayed alarm responses, communication breakdowns, and increased stress and burnout among HCPs. Identified strategies for reducing Alarm Fatigue included training programs, technical improvements (e.g., alarm customization), protocol adjustments, and broader organizational interventions.

Conclusions: The review highlights Alarm Fatigue as a complex and clinically relevant issue. By proposing a harmonized definition and mapping key findings across five domains, it offers a structured foundation for future research. Standardized definitions and measurement tools, along with targeted multi-level interventions, are essential for addressing Alarm Fatigue and improving both patient safety and working conditions in healthcare.

Trial registration: The review was preregistered on the website https://aspredicted.org with the preregistration number #169,578.

Clinical trial number: Not applicable.

Keywords: Alarm fatigue; Healthcare quality improvement; Nurses; Patient safety; Well-being at work.

Fig. 1

Alarm fatigue represented through a chain figure

Fig. 2

PRISMA Flow diagram of the study selection process (Preferred reporting Items for systematic reviews and meta-analyses)

Fig. 3

Graphical summary of the review’s objectives