User-Centered Redesign of Monitoring Alarms: A Pre-Post Study on Perception, Functionality, and Recognizability Following Real-Life Clinical Implementation.

Background: Auditory alarms in patient monitoring are vital for clinical safety, but their harsh acoustic properties and high frequency contribute to stress, alarm fatigue, and reduced acceptance among healthcare staff. In collaboration with Sen Sound, Philips redesigned its alarm sounds to reduce auditory harshness, particularly for low- and medium-priority alarms, while preserving the salience of high-priority alerts. This study evaluated the impact of these refined alarm sounds in a real-world clinical setting. Objective: The goal was to determine whether anesthesia professionals perceive the refined Philips alarm sounds as more pleasant, clinically appropriate, and reliably recognizable compared with the traditional sounds. Methods: We conducted a single-center, pre-post intervention study at the University Hospital Zurich, Switzerland. Anesthesia providers assessed traditional and refined Philips alarm sounds with respect to perceived sound appeal, perceived functionality, and recognition accuracy. The primary outcome (sound appeal) was tested for superiority; using mixed-effects regression models. Results: Seventy-seven participants completed both study phases. Refined alarm sounds significantly improved perceived sound appeal (mean difference +0.51; 95% CI, 0.37-0.64; p < 0.001), while perceived functionality showed a small decrease (mean difference -0.15; 95% CI, -0.27 to -0.03). Recognition accuracy for low- and medium-priority alarms was higher with traditional sounds (low: 95.2% vs. 87.5%, p = 0.002; medium: 81.1% vs. 62.0%, p < 0.001), while high-priority alarms were more accurately identified with refined sounds (89.0% vs. 81.4%, p = 0.002). Overall, 71% of participants preferred the refined sounds, and 92% supported further development. Conclusions: Refined alarm sounds reduced perceived harshness and improved auditory comfort for anesthesia providers, but were associated with slightly lower perceived functionality and mixed recognition accuracy. High-priority alarms were identified more reliably, whereas low- and medium-priority alarms were less distinctly recognized, indicating a limited trade-off between sound appeal and clarity that primarily affected lower-priority signals. These findings suggest that while refinement can enhance the auditory environment, further development, potentially incorporating auditory icons or voice-based alerts, will be needed to optimize both user experience and patient safety in clinical practice.