Designing alarms to address the increasing complexity of dynamic and interconnected systems in current socio-technological environments presents multi-faceted design problems that require systematic thinking and a collaborative and holistic approach. To understand the alarm design challenges better, we map out the design space for audible alarms in an applied domain, covering the alarm issues from the designers’ perspective, departing from the functional integrity of alarms, and bringing together the contribution of three major fields of expertise related to audible alarms (systems engineering, information design, and human factors). Three studies based on literature review, field observations, expert interviews, and focus groups are conducted by authors at different European Intensive Care Units. Our findings from these studies result in the definition of the components of audible alarm design, the key considerations for designing audible alarms, and a design framework for audible alarms that systematically integrates input from inter-connected disciplines that all aim for the success of a complex system that heavily relies on alarms.

Neonatal Intensive Care Units (NICU) are environments with a high level of sensory stress. Medical advances and technology have contributed to increase the ratio of survival of premature infants but some devices and practices expose these babies to excessive noise and toxic sensory stimuli for which they are not prepared. This is related to an increase of neonatal morbidities, that are considered as minor sequelae, but that can greatly alter the life of the child and the family. Those responsible for hospital management and caregivers who want to take a step forward, need standards to guarantee the benefit of neonatal health and a proper physical and cognitive development of these babies. Design activity, from a Human-Centered Design approach (HCD), together with Developmental Centered Care (DC) contribute to identify and reduce adverse environmental conditions for newborns and premature infants. The purpose of this paper is to establish a method to provide design recommendations and good practice guidelines from evidence and especially from in-situ observations carried out in neonatal units by a multidisciplinary team (i.e., nurses, NICU supervisors and designers). Thus, we identify proposals to reduce stress situations and obtain potential benefits in the development of the hospitalized infant through adaptation of the NICU macroenvironment (i.e. the reduction of light and noise).

Intensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called 'alarm fatigue' and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.