Patent Publication Number: US-2017367662-A1

Title: Multi-layer alarming

Description:
BACKGROUND 
     The following relates generally to alerting a clinician, and more specifically to multi-layer alarming. 
     In a healthcare facility such as a hospital, physiological parameters of the patient (e.g., heart rate, respiratory rate, blood pressure) may be monitored by one or more medical devices. The medical devices may be battery powered and may wirelessly transmit measured patient data over a wireless network within the hospital, thereby allowing the patient to move freely through the hospital while being monitored. Clinicians may remotely monitor the patient by accessing the patient data at a central nurse station or on any web enabled device connected to the network (e.g., smartphone or tablet). Other information related to the patient (e.g., location information, patient identification information, responsible clinician) may also be recorded and stored at a central nurse station or otherwise made available to clinicians. 
     When multiple patients are being monitored, alarms from several medical devices may be transmitted and sounded at a central nurse station or on a mobile device carried by a clinician. Because multiple alarms from multiple patients may be sounding simultaneously, it may be difficult for a clinician to discern relevant patient information or determine clinician responsibility simply by listening to the alarms. Also, the multiple alarms at the nurse station may contribute to alarm fatigue, because each clinician can hear all of the alarms, regardless of who is the responsible clinician or whether the alarm requires immediate attention. If the sounding alarm is urgent, any delay in responding to the alarm could put a patient or multiple patients at risk. 
     SUMMARY 
     The described features generally relate to methods and devices for alerting a clinician by sounding an alarm having multiple layers (i.e., a multi-layer alarm). Each layer of the multi-layer alarm may indicate certain information associated with a patient being monitored by one or more medical devices. For example, a first layer of the multi-layer alarm may identify a severity of a measured physiological parameter, such as heart rate, blood pressure, temperature, respiratory rate, activity level, or oxygen saturation level of the patient. A second layer of the multi-layer alarm may indicate other information such as a clinician responsible for the patient being monitored. 
     To alert a clinician, the multi-layer alarm may be audibly transmitted (e.g., using a speaker). Each layer of the multi-layer alarm may correspond with layer properties such as pitch, volume, and periodicity, which define each layer and different each layer from another layer of the multi-layer alarm. 
     Embodiments of systems and devices for multi-layer alarming are also described. In accordance with certain aspects, an apparatus for multi-layer alarming includes a processor, memory in electronic communication with the processor, and instructions stored in the memory. The instructions stored in the memory may be operable, when executed by the processor, to cause the apparatus to encode a multi-layer alarm associated with a patient, encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient, encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter, and audibly transmit the multi-layer alarm. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates an example of a system for wireless patient monitoring that supports multi-layer alarming in accordance with aspects of the present disclosure. 
         FIG. 2  illustrates an example of a system for wireless patient monitoring that supports multi-layer alarming in accordance with aspects of the present disclosure. 
         FIG. 3  illustrates an example of a multi-layer alarm in accordance with aspects of the present disclosure. 
         FIGS. 4A-4D  illustrate examples of a multi-layer alarm in accordance with aspects of the present disclosure. 
         FIGS. 5 through 7  show block diagrams of a device that supports multi-layer alarming in accordance with aspects of the present disclosure. 
         FIG. 8  illustrates a block diagram of a system including a device that supports multi-layer alarming in accordance with aspects of the present disclosure. 
         FIGS. 9 and 10  illustrate methods for multi-layer alarming in accordance with aspects of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     In a healthcare facility, multiple alarms from several patients may be sounding at a central nurse station, each of which may pertain to different information of the patient. The alarms may be sound from a variety of different medical devices used to monitor the patient. In some cases, multiple medical devices may be used to monitor a single patient, each of which may sound an alarm based on certain criteria. For example, a medical device may be used to monitor the heart rate of a patient and may sound when the heart rate falls below a minimum threshold. Another medical device may be used to monitor the respiratory rate of the patient and may sound when the respiratory rate reaches a maximum threshold. 
     When multiple alarms are being sound from multiple medical devices monitoring a patient, the clinician(s) responsible for the patient may be unable to discern relevant information (such as whether the patient needs immediate attention) from the multiple alarms. Further, if a clinician or group of clinicians are responsible for monitoring multiple patients, it may also be difficult to discern which alarm corresponds to a particular patient when multiple alarms are being sound. However, by generating a multi-layer alarm in accordance with aspects of the present disclosure, a clinician or a group of clinicians monitoring one or more patients may be able to discern relevant information and responsibilities more quickly and accurately. 
     In one or more embodiments, the multi-layer may be encoded with multiple audible layers, each of which being associated with layer properties such as pitch, volume, and periodicity. Each layer of the multi-layer alarm may indicate information related to a patient being monitored. Once generated, the multi-layer alarm may be audibly transmitted in order to alert one or more clinicians of relevant information relating to the patient. 
       FIG. 1  illustrates an example of a wireless patient monitoring system  100  in accordance with various embodiments of the present disclosure. The wireless patient monitoring system  100  may include a patient  105  wearing, carrying, or otherwise coupled with a medical device  110 . Although a single medical device  110  is shown, multiple medical devices  110  may be coupled to the patient  105 . The patient  105  may be a patient in a hospital, nursing home, home care, a medical facility, or another care facility. The medical device  110  may transmit signals via wireless communications links  150  to computing devices  115  or to a network  125 . In some cases, the medical device  110  may be used in conjunction with another medical device  110  to generate a multi-layer alarm. 
     Computing device  115 - a  may be a wireless device such as a tablet, cellular phone, personal digital assistant (PDA), dedicated receiver, a wireless laptop computer, a mobile computer station or other similar device or a spatially distributed network of devices configured to receive signals from the medical device  110 . Computing device  115 - b  may be an in-room patient monitoring device, a Workstation on Wheels, or a smart hospital bed which may be linked to the network  125  and medical device  110  using wireless links  150 . Computing device  115 - b  may be configured to gather or receive data associated with the patient  105  using multiple sources and may also include a medical device  110  used to monitor parameters or collect data from the patient  105 . The computing devices  115  may be in communication with a central station  135  via network  125 . 
     The medical device  110  may also communicate directly with the central station  135  via the network  125 . The central station  135  may be a server located within the hospital or in a remote location and may be in communication with a nurse station  120  using wireless links  150 . The central station  135  may be in further communication with one or more remote computing devices  145 , thus allowing a clinician to remotely monitor the patient  105 . The central station  135  may also be in communication with various remote databases  140  where the collected patient data may be stored. In some cases, the remote databases  140  include electronic medical records (EMR) applications for storing and sharing patient data. 
     The medical device  110  may include one or more sensors configured to collect a variety of physiological parameters as well as information related to the location and movement of the patient  105 . For example, the medical device  110  may include a pulse oximetry (SpO2) sensor, a heart rate sensor, a blood pressure sensor, a pressure sensor, an electrocardiogram (ECG) sensor, a respiratory rate sensor, a glucose level sensor, a body temperature sensor, an accelerometer, a global positioning sensor, a sensor which triangulates position from multiple computing devices  115 , or any other sensor configured to collect physiological, location, or motion data. 
     The medical device  110  may be coupled with the patient  105  in a variety of ways depending on the data being collected. For example, the medical device  110  may be directly coupled with the patient  105  (e.g., physically connected to the patient&#39;s chest, worn around the patient&#39;s wrist, or attached to the patient&#39;s finger). The sensor may be indirectly coupled with the user so that movement of the patient  105  is detected even though the sensor is not in direct contact with, or physically connected to, the patient  105  (e.g., the medical device  110  may be disposed under the patient  105 ). The data collected by the medical device  110  may be wirelessly conveyed to either the computing devices  115  or to the remote computing device  145  (via the network  125  and central station  135 ). Data transmission may occur via, for example, frequencies appropriate for a personal area network (such as Bluetooth, Bluetooth Low Energy (BLE), or IR communications) or local (e.g., wireless local area network (WLAN)) or wide area network (WAN) frequencies such as radio frequencies specified by IEEE standards (e.g., IEEE 802.15.4 standard, IEEE 802.11 standard (Wi-Fi), IEEE 802.16 standard (WiMAX), etc.). 
     In accordance with various embodiments, the nurse station  120  may be used to monitor the patient  105  and may obtain data associated with the patient  105  from the medical device  110 . Data may also be obtained by the nurse station  120  from the network  125  or from the server  135  or remote databases  140  using wireless links  150  or may be obtained from the medical device  110  or computing devices  115 . The obtained data may then be displayed or otherwise accessible using the nurse station  120  so that nurses (or other clinicians) are able to monitor the patient  105  (and other patients). 
     The medical device  110  may be configured to trigger or sound an alarm based on certain criteria associated with the medical device and the patient. In some cases, the alarm is sound at the medical device  110  within the room of the patient  105 . Additionally or alternatively, the medical device  110  may trigger an alarm to be sent to a remote location (e.g., nurse station  120 ), where the alarm is sound. The medical device  110  may monitor a physiological parameter of the patient such as heart rate, respiratory rate, blood pressure, etc., and may trigger or sound an alarm when the measure physiological parameter crosses a threshold. The medical device  110  may also sound an alarm based on a status of the medical device. For instance, if the medical device  110  experiences a technical issue such as a startup failure or has a low battery, an alarm may be triggered or sound. 
     In some aspects, the medical device  110 , the nurse station  120 , or the computing devices  115  may be configured to generate and/or audibly transmit a multi-layer alarm. For example, the nurse station  120  or the computing devices  115  may be linked to the medical device  110  and may sound a multi-layer alarm based on data received from the medical device  110 . In some embodiments, the multi-layer alarm may be sound at the nurse station  120  or the computing devices  115  in conjunction with or based on the alarm from the medical device  110 . 
       FIG. 2  illustrates an example of a wireless patient monitoring system  200  for multi-layer alarming. In some cases, the wireless patient monitoring system  200  may represent aspects of techniques performed by a computing devices  115 , medical devices  110 , or nurse station  120  as described with reference to  FIG. 1 . 
     As shown in  FIG. 2 , multiple patients  105  are located in different rooms  205  and may be monitored by one or more clinicians  210 . In  FIG. 2 , patient  105 - a  is located in room  205 - a , patient  105 - b  is located in room  205 - b , patient  105 - c  is located in room  205 - c , and patient  105 - c  is located in room  205 - c . The rooms  205  may be located throughout a healthcare facility (e.g., each room may be on a different floor of a hospital) or may be located in different healthcare facilities remote from clinicians  210 . For example, patient  105 - a  in room  205 - a  may be located at home, patients  105 - b  and  105 - c  may be located in an intensive care area of a healthcare facility, and patient  105 - d  may be located in room  205 - d  in a healthcare facility different from the other patients  105 - b  and  105 - c , but in the same area (e.g., the same floor of a hospital) as nurse station  120 - a.    
     Clinicians  210  may monitor patients  105  using medical devices  110 , nurse station  120 - a , or other devices such as computing device  115 - a . Each patient  105  may be monitored by medical devices  110  connected to, or otherwise associated with, a patient  105 . For example, medical device  110 - a  may be worn by patient  105 - a  to monitor heart rate of the patient  110 - a . Medical device  110 - b  may not be directly attached to patient  105 - b , but may indirectly measure movement of patient  110 - b . Patient  105 - c  may be monitored by multiple medical devices  110 - c ,  110 - d , and  110 - e . As shown, medical device  110 - c  is directly attached to patient  105 - c  and may monitor a physiological parameter of the patient  105 - c . Medical devices  110 - d  and  110 - e  may indirectly monitor other parameters of the patient  105 - c . While each of medical devices  110 - c ,  110 - d , and  110 - e  may measure different parameters of the patient  105 - c , in some cases, medical devices  110 - c ,  110 - d , and  110 - e  may be used in conjunction with one another to monitor one or more parameters associated with the patient  105 - c . Patient  105 - d  may be monitored using medical devices  110 - f  and  110 - g , each of which may be configured to monitor different parameters associated with the patient  105 - d  or may be used in conjunction with each other to monitor one or more parameters of the patient  105 - d.    
     In some cases, medical devices  110  may be used in conjunction with other devices to monitor the patients  105 . Medical devices  110  may wirelessly communicate with one another through network  125 - a  or may be directly connected to each other when monitoring patients  105 . Medical devices  110  may also communicate with nurse station  120 - a  or computing device  115 - a  so that nurses  210  are able to monitor patients  105  from one location even though the patients  105  are in different locations. For example, medical devices  110  may transmit data to nurse station  120 - a  or computing devices  115 - a  via network  125 - a . Alternatively, nurse station  120 - a  may request or retrieve data from one or more medical devices  110  without the medical devices  110  having to transmit the data. For example, data from a medical device  110  may be stored on the medical device  110  and may only be viewable by a responsible clinician  210 . The responsible clinician  210  may then use nurse station  120 - a  to access or retrieve the data stored on medical device  110 . The transmitted or retrieved data may then be viewable or otherwise accessible by clinicians  210  to monitor the patients  105 . 
     The data from one or more medical devices  110  may include alarms that may be triggered when a parameter being measured by a medical device  110  crosses a threshold, for example. In some cases, the medical device  110  may sound an alarm or may transmit information to the nurse station  120 - a  or computing device  115 - a  triggering the nurse station  120 - a  or computing device  115 - a  to also sound an alarm. The thresholds for sounding an alarm may be patient specific in that each patient  105  may be associated with different thresholds for different medical devices  110  used to monitor the patient  105 . For example, patient  105 - a  may be in room  205 - a  at home and may be relatively active compared to patient  105 - c  in intensive care. Therefore, the heart rate of patient  105 - a  monitored by medical device  110 - a  may have a relatively high threshold for sounding (or triggering) an alarm compared to the threshold for an alarm associated with patient  205 - c  (monitored by medical device  110 - c , for example). 
     In one or more embodiments, nurse station  120 - a  may obtain data from medical devices  110  for monitoring patients  105 . The nurse station  120 - a  may sound an alarm based on information received or obtained from medical devices  110 . Further, multiple alarms may be sound from the nurse station  120 - a  for each patient  105  or for multiple patients  105 . For example, data from medical device  110 - a  may cross a threshold for patient  105 - a  and an alarm  220 - a  may be sound from nurse station  120 - a . In addition, data from medical devices  110 - c  and  110 - d  may also cross a threshold for patient  105 - c , and an alarm  220 - b  (or multiple alarms associated with each medical device  110 - c  and  110 - d ) may be sound from nurse station  120 - a . Medical device  110 - g  monitoring patient  105 - d  may also sound an alarm  220 - c  from room  205 - d , which is in the same area as nurse station  120 - a . Computing device  115 - a  may be a mobile computing device  115 - a  for clinician  210 - b  and may communicate with medical devices  110  or nurse station  120 - a . In some cases, computing device  115 - a  may also sound an alarm  220 - d  based on one or more medical devices  110  or the alarms  220 - a  or  220 - b  from nurse station  120 - a . In such situations, multiple alarms  220  from multiple sources (nurse station  120 - a , room  205 - d , computing device  115 - a , etc.) may be sound at the same time which may lead to clinicians  210  having difficulty discerning relevant information from each of the alarms  220 . 
     Additionally, while each of clinicians  210 - a ,  210 - b , and  210 - c  may be responsible for monitoring each patient  105 , in some cases, certain clinicians  210  may be responsible for only certain patients  105  or medical devices  110 . Clinician  210 - a  may be a cardiologist and may be responsible for monitoring the heart rate of each patient  105  and may therefore not be concerned with alarms  220  (or medical devices  110 ) that are not related to heart rate of the patients  105 . Clinician  210 - b  may only be responsible for patient  105 - b  (e.g., in intensive care) and may therefore not be concerned with alarms  220  associated with other patients  105 - a ,  105 - c , and  105 - d . Clinician  210 - c  may only be responsible for local patients, such as patient  105 - d  located in room  205 - d  in the same area as nurse station  120 - a . Accordingly, as different clinicians  210  have different responsibilities, multiple sounding alarms  220  may not always be beneficial to each clinician  210  and could possibly cause clinicians  210  to naturally tune out multiple sounding alarms  220 , not pay attention to most alarms  220 , or have difficulty in determining whether an alarm  220  requires immediate attention by a certain clinician  210 . The multiple sounding alarms  220  heard by multiple clinicians  210  who may not be responsible for responding to certain alarms  220  may lead to alarm fatigue for the clinicians  210 . 
     In accordance with the present disclosure, a multi-layer alarm  220  may be generated having multiple audible layers of information related to the alarm  220 , the patient  105 , or the clinician responsible  210  for the patient  105 . Each audible layer of the multi-layer alarm  220  may have corresponding layer properties which may include one or more of pitch, volume, and periodicity. Pitch may refer to the frequency of the acoustic wave associated with the layer when the multi-layer alarm is audibly transmitted. Volume may refer to the amplitude of the acoustic wave associated with the layer when the multi-layer alarm is audibly transmitted, and periodicity may refer to the number of times the acoustic wave is to be transmitted over a specific time interval. 
     The multi-layer alarm  220  may be generated by medical devices  110 , nurse station  120 - a , or computing device  115 - a . A first audible layer of the multi-layer alarm may include information related to a measured parameter associated with a patient  105 . For example, the first audible layer of the multi-layer alarm may identify the parameter of the patient  105  being measured by a medical device  110 . For example, the first audible layer of the multi-layer alarm may indicate that the parameter of the patient  105  being monitored is a physiological parameter such as respiratory rate. The first audible layer may additionally, or alternatively, indicate the severity of the physiological parameter being measured based on the importance of the parameter (e.g., respiratory rate may be more severe than heart rate). In some cases, physiological parameters may be grouped into different severity categories based on how important the physiological parameter is to the health of the patient  105 . For example, respiratory rate and heart rate may be grouped into a high severity category, oxygen saturation and temperature may be grouped into a medium severity category, and activity level may be grouped into a low severity category. In such instances, the first audible layer may indicate the severity of the physiological parameter and whether or not the physiological parameter is of high, medium, or low severity. The grouping of the physiological parameters may depend on the patient  105 , the health of the patient  105 , and the current condition or procedure in which the patient  105  is undergoing or has previously undergone. As such, different parameters may be grouped into different severity categories and other groupings of parameters may be considered without departing from the scope of the present disclosure. 
     In some embodiments, each of the physiological parameters within a severity group may have corresponding alarm thresholds of different criticalities (e.g., low criticality, medium criticality, and high criticality). For example, a medium severity physiological parameter, e.g., temperature, may be associated with a low criticality alarm threshold indicating that the temperature is slightly abnormal, but the patient  105  may not require immediate attention. The temperature may also be associated with a medium criticality alarm threshold indicating that the measured temperature is more abnormal (or worsening) and the patient  105  may soon require attention. Further, the temperature may also be associated with a high criticality alarm threshold and should the measured temperature reach the high criticality alarm threshold, the patient  105  may need immediate attention. 
     In some cases, a physiological parameter may be included in multiple severity categories based on the criticality of the alarm threshold corresponding the physiological parameter. For example, a physiological parameter such as heart rate may be associated with a low criticality alarm threshold, a medium criticality alarm threshold, and a high criticality alarm threshold. Heart rate along with a corresponding high criticality alarm threshold may be grouped into a high severity category, while the heart rate along with corresponding low and medium criticality alarm threshold may be grouped into a medium severity category. In another example, temperature may be associated with a high criticality alarm threshold and a low criticality alarm threshold and may be grouped based on the criticality of the alarm threshold. For instance, temperature along with a corresponding high criticality alarm threshold may be grouped into a high severity category, while temperature along with a corresponding low criticality alarm threshold may be grouped into a low severity category. Other groupings and corresponding criticalities of alarm thresholds associated with a measured physiological parameter may be considered without departing from the scope of the present disclosure. 
     A second audible layer of the multi-layer alarm may indicate other information associated with the medical device  110  or the patient  105 , such as the clinician responsible for the patient  105 , or the medical device  110  that triggered the alarm, or how long the patient  105  has been unattended. In some embodiments, the second audible layer of the multi-layer alarm may indicate that the measured physiological parameter has reached a particular alarm threshold (e.g., a low criticality alarm threshold, a medium criticality alarm threshold, or a high criticality alarm threshold). For example, the first audible layer of the multi-layer alarm may indicate severity of the measured physiological parameter, while the second audible layer of the multi-layer alarm may indicate the criticality of the measured physiological parameter. Thus, severity of the measured physiological parameter and the criticality of the measured physiological parameter may be indicated by the first and second audible layers of the multi-layer alarm. 
     In some instances, the severity and criticality of a physiological parameter may be indicated in a single audible layer. For example, a first audible layer may include layer properties (e.g., volume, pitch, periodicity) that indicates both the severity of the physiological parameter being measured and the criticality associated with the measured physiological parameter. 
     The multi-layer alarm may be sound at a medical device  110  associated with the alarm, at the nurse station  120 - a , or at the computing device  115 - a . The multi-layer alarm may then be repeated over a given time period. As the multi-layer alarm is generated with audible layers of information relating to the patient  105 , the clinicians  210  may hear the multi-layer alarm and may be able to quickly discern relevant information (e.g., the severity of the alarm, the criticality of the alarm, which clinician  210  is responsible, whether the patient  105  requires immediate attention) related to the medical device  110 , the parameter being measured, the patient, or the responsible clinician  210 . 
       FIG. 3  illustrates an example of a multi-layer alarm  300  in accordance with aspects of the present disclosure. In some cases, the multi-layer alarm  300  may represent aspects of techniques performed by a medical device  110 , computing device  115 , or nurse station  120  as described with reference to  FIGS. 1 and 2 . For example, a medical device  110 , a computing device  115 , or a nurse station  120  may audibly transmit multi-layer alarm  300 . 
     In  FIG. 3 , the multi-layer alarm  300  includes multiple audible layers  305  and spans a time period  310 . Each of the multiple audible layers  305  span a corresponding time interval  315 . Though the multi-layer alarm  300  spans time period  310 , the multi-layer alarm  300  may be repeated when audibly transmitted over a given duration. For example, if time period  310  is ten seconds, the multi-layer alarm  300  may repeat six times over a one minute duration. Alternatively, the multi-layer alarm  300  may intermittently repeat over a duration (e.g., one time, two times, or three times over a one minute duration). The repetitions of multi-layer alarm  300  may be equally spaced over a duration or may be spaced differently over the duration. While a time period of ten seconds and a duration of one minute is described herein, any other time periods or durations may be considered without departing from the scope of the present disclosure. 
     Each layer  305  may indicate or identify information related to a patient such as a measured parameter, severity of the measured parameter, or a clinician responsible for the patient. In addition, each layer  305  may have corresponding layer properties such as pitch, volume, and periodicity to uniquely define or indicate such information and distinguish it from another layer  305 . For example, layer  305 - a  may correspond with a given pitch and volume, but may not be repeated over the time period  310  (i.e., no periodicity). Layer  305 - a  may identify a measured parameter of the patient such as a physiological parameter or a severity of the measured parameter of the patient. 
     In one or more embodiments, multiple layers  305  may be used to indicate or identify information related to a patient. For example, layers  305 - b  and  305 - c  may each have corresponding layer properties that collectively may be used to indicate a measured parameter of the patient or a clinician responsible for the patient. In another example, layers  305 - d ,  305 - e ,  305 - f , and  305 - g  may have the same pitch and volume properties and may repeat over time period  310  (i.e., periodic). In some cases, the time interval  315  over which a layer  305  spans may vary depending on the layer  305 . For example, layers  305 - h  and  305 - i  span different time intervals compared to other layers  305  of the multi-layer alarm  300  and may repeat twice over time period  310 . 
       FIGS. 4A-4D  illustrate examples of multi-layer alarms  400  in accordance with aspects of the present disclosure. In some cases, the multi-layer alarms  400  may represent aspects of techniques performed by a medical device  110 , computing device  115 , or nurse station  120  as described with reference to  FIGS. 1 and 2 . For example, a medical device  110 , a computing device  115 , or a nurse station  120  may audibly transmit multi-layer alarms  400 . 
     In  FIG. 4A , a multi-layer alarm  400 - a  is shown spanning time period T 1  and includes layers  405 - a ,  405 - b , and  405 - c . Each of the layers  405 - a ,  405 - b , and  405 - c  may indicate information associated with a patient being monitored by a medical device (e.g., medical device  110 ) and include corresponding layer properties such as pitch and periodicity. As shown, layer  405 - a  has a pitch P 1  and is continuous over time period T 1 . Layer  405 - b  has a pitch P 2  and repeats twice over time period T 1 . However, layer  405 - b  begins after a delay. Layer  405 - c  has a pitch P 3  and repeats thirteen times over time period T 1 . In some embodiments, two or more of layers  405 - a ,  405 - b , and  405 - c  may collectively indicate information associated with the patient. For example, layer  405 - a  may indicate the responsible clinician for a particular patient, layer  405 - b  may indicate the physiological parameter that triggered the alarm, and layer  405 - c  may indicate where the patient is located within the healthcare facility. 
     In  FIG. 4B , a multi-layer alarm  400 - b  is shown spanning time period T 2  and includes layers  405 - d ,  405 - e , and  405 - f . Each of the layers  405 - d ,  405 - e , and  405 - f  may indicate information associated with a patient being monitored by a medical device (e.g., medical device  110 ) and include corresponding layer properties such as pitch and periodicity. As shown, layer  405 - d  has a pitch P 4  and repeats twelve times over time period T 2 , but begins after a delay. Layer  405 - e  has a pitch P 5  and repeats twice over time period T 2 , but ends with a delay. Layer  405 - f  has a pitch P 6  and repeats six times over time period T 2  and also begins after a delay. In some embodiments, two or more of layers  405 - d ,  405 - e , and  405 - f  may collectively indicate information associated with the patient. For example, layer  405 - d  may indicate the physiological parameter that triggered the alarm, layer  405 - e  may indicate that the measured physiological parameter has escalated recently (e.g., the measured parameter or overall condition of the patient was worsened), and layer  405 - f  may indicate the clinician responsible for the patient. 
     In  FIG. 4C , a multi-layer alarm  400 - c  is shown spanning time period T 3  and includes layers  405 - g ,  405 - h ,  405 - i  and  405 - j . Each of the layers  405 - g ,  405 - h ,  405 - i  and  405 - j  may indicate information associated with a patient being monitored by a medical device (e.g., medical device  110 ) and include corresponding layer properties such as volume and periodicity. As shown, layer  405 - g  has a volume V 1  and is continuous after a delay over time period T 3 . Layer  405 - h  has a Volume V 2  and repeats twice over time period T 3 , but begins with a delay. Layer  405 - i  has a volume V 3  and repeats five times over time period T 3  but ends with a delay. Layer  405 - j  has a volume V 4  and repeats six times over time period T 3  but ends with a delay. In some embodiments, two or more of layers  405 - g ,  405 - h ,  405 - i  and  405 - j  may collectively indicate information associated with the patient. For example, layer  405 - g  may indicate the severity (e.g., high, medium, or low severity) associated with the alarm, layer  405 - h  may indicate the clinician responsible for the patient, layer  405 - i  may indicate that the patient has been left unattended for a certain amount of time, and layer  405 - j  may indicate the device type that triggered the alarm. 
     In  FIG. 4D , a multi-layer alarm  400 - d  is shown spanning time period T 4  and includes layers  405 - k  and  405 - 1 . Each of the layers  405 - k  and  405 - 1  may indicate information associated with a patient being monitored by a medical device (e.g., medical device  110 ) and include corresponding layer properties such as volume and periodicity. As shown, layer  405 - k  has a volume V 5  and repeats twelve times over time period T 4 , but begins with a delay. Layer  405 - 1  has a volume V 6  and repeats three times over time period T 4  but begins and ends with a delay. In some embodiments, layers  405 - k  and  405 - 1  may collectively indicate information associated with the patient. For example, layer  405 - k  may indicate the severity (e.g., high, medium, or low severity) or the criticality associated with a physiological parameter that triggered the alarm, and layer  405 - 1  may indicate location of the patient. 
       FIG. 5  shows a block diagram  500  of a device  505  that supports multi-layer alarming in accordance with various aspects of the present disclosure. Device  505  may be an example of aspects of a medical device  110 , computing device  115 , or nurse station  120 , as described with reference to  FIGS. 1 and 2 . 
     As shown, device  505  may include input  510 , multi-layer alarm manager  515 , and output  520 . Device  505  may also include a processor. Each of these components may be in communication with one another (e.g., via one or more buses). 
     Multi-layer alarm manager  515  may encode a multi-layer alarm associated with a patient. The multi-layer alarm manager  515  may encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient and encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter. The multi-layer alarm manager  515  may also audibly transmit the multi-layer alarm. In some embodiments, multi-layer alarm manager  515  may be an example of aspects of the multi-layer alarm manager  815  described with reference to  FIG. 8 . 
       FIG. 6  shows a block diagram  600  of a device  605  that supports multi-layer alarming in accordance with various aspects of the present disclosure. Device  605  may be an example of aspects of a device  505  or a medical device  110  as described with reference to  FIGS. 1, 2 and 5 . Device  605  may include input  610 , multi-layer alarm manager  615 , and output  620 . Device  605  may also include a processor. Each of these components may be in communication with one another (e.g., via one or more buses). 
     Multi-layer alarm manager  615  may include alarm generator  625 , first layer encoder  630 , second layer encoder  635 , and audible transmitter  640 . Alarm generator  625  may encode a multi-layer alarm associated with a patient. In one or more embodiments, encoding the multi-layer alarm is based on a measured parameter (e.g., measured by a medical device  110 ) crossing a threshold. In some cases, encoding the multi-layer alarm may be based on a status or a technical issue associated with device  605  or other device (e.g., medical device  110 , nurse station  120 , computing device  115 ). In some cases, encoding the multi-layer alarm includes determining one or more layer properties for each audible layer of the multi-layer alarm such as a volume, a pitch, or a periodicity. 
     First layer encoder  630  may encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient. The first layer audible layer may be uniquely defined by one or more layer properties to identify the severity of the measure parameter of the patient. 
     Second layer encoder  635  may encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter. In some cases, the information other than the identified severity of the measured parameter includes a clinician responsible for the patient or a duration of alarm transmission without clinician intervention. In one or more embodiments, the second audible layer may include an escalation level associated with the measured parameter, a device type associated with measuring the measured parameter, or a technical issue of a medical device (e.g., medical device  110 ) associated with the patient. The second audible layer may also indicate a patient location or a criticality of the measured physiological parameter. 
     Audible transmitter  640  may audibly transmit the multi-layer alarm. In some cases, audibly transmitting the multi-layer alarm may include audibly transmitting both the first and second audible layers contemporaneously or sequentially or periodically over a given time interval. 
     In one or more embodiments, multi-layer alarm manager  615  may be an example of aspects of the multi-layer alarm manager  815  described with reference to  FIG. 8 . 
       FIG. 7  shows a block diagram  700  of a multi-layer alarm manager  715  that supports multi-layer alarming in accordance with various aspects of the present disclosure. The multi-layer alarm manager  715  may be an example of aspects of a multi-layer alarm manager  515 , a multi-layer alarm manager  615 , or a multi-layer alarm manager  815  described with reference to  FIGS. 5, 6, and 8 . The multi-layer alarm manager  715  may include alarm generator  725 , first layer encoder  730 , second layer encoder  735 , and audible transmitter  740 . Each of these modules may communicate, directly or indirectly, with one another (e.g., via one or more buses). 
     Alarm generator  725  may encode a multi-layer alarm associated with a patient. In one or more embodiments, encoding the multi-layer alarm is based on a measured parameter (e.g., measured by a medical device  110 ) crossing a threshold. In some cases, encoding the multi-layer alarm may be based on a status or a technical issue associated with a device (e.g., medical device  110 , nurse station  120 , computing device  115 ). In some cases, encoding the multi-layer alarm includes determining one or more layer properties for each audible layer of the multi-layer alarm such as a volume, a pitch, or a periodicity. 
     First layer encoder  730  may encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient. The first layer audible layer may be uniquely defined by one or more layer properties to identify the severity of the measured parameter of the patient. 
     Second layer encoder  735  encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter. In some cases, the information other than the identified severity of the measured parameter includes a clinician responsible for the patient or a duration of alarm transmission without clinician intervention. In one or more embodiments, the second audible layer may include an escalation level associated with the measured parameter, a device type associated with measuring the measured parameter, or a technical issue of a medical device (e.g., medical device  110 ) associated with the patient. The second audible layer may also indicate a patient location or a criticality of the measured parameter. 
     Audible transmitter  740  may audibly transmit the multi-layer alarm. In some cases, audibly transmitting the multi-layer alarm may include audibly transmitting both the first and second audible layers contemporaneously or sequentially or periodically over a given time interval. 
     Physiological sensor  745  may measure a parameter of the patient (e.g., using medical device  110 ). In some cases, the measured parameter includes a physiological parameter of the patient such as a heart rate, a respiratory rate, a blood pressure, a temperature, an activity level, or an oxygen saturation level. 
     Status monitor  750  may determine a status of one or more devices (e.g., medical device  110 , nurse station  120 , or computing device  115 ). For example, the status monitor  750  may determine a low battery indication associated with the device or a loss of power to the device. The status monitor  750  may also determine a self-test failure associated with the device, a startup failure of the device, or other technical issue associated with the device. 
       FIG. 8  shows a diagram of a system  800  including a device  805  that supports multi-layer alarming in accordance with various aspects of the present disclosure. Device  805  may be an example of a device  505 , device  605 , a medical device  110 , nurse station  120 , or computing device  115 , as described above, e.g., with reference to  FIGS. 1, 2, 5, and 6 . 
     Device  805  may include components for bi-directional voice and data communications or components for transmitting and receiving communications. Device  805  may also include multi-layer alarm manager  815 , processor  825 , memory  830 , software  835 , I/O controller  840 , and speaker  845 . 
     Processor  825  may include an intelligent hardware device, (e.g., a central processing unit (CPU), a microcontroller, an application specific integrated circuit (ASIC), etc.) 
     Memory  830  may include random access memory (RAM) and read only memory (ROM). The memory  830  may store computer-readable, computer-executable software  835  including instructions that, when executed, cause the processor to perform various functions described herein. In some cases, the memory  830  may contain, among other things, a Basic Input-Output system (BIOS) which may control basic hardware and/or software operation such as the interaction with peripheral components or devices. 
     Software  835  may include code to implement aspects of the present disclosure, including code to support multi-layer alarming. Software  835  may be stored in a non-transitory computer-readable medium such as system memory or other memory. In some cases, the software  835  may not be directly executable by the processor but may cause a computer (e.g., when compiled and executed) to perform functions described herein. 
     I/O controller  840  may manage input and output signals for device  805 . In some cases, I/O controller  840  may utilize an operating system such as iOS®, ANDROID®, MS-DOS®, MS-WINDOWS®, OS/2®, UNIX®, LINUX®, or another known operating system. 
     Speaker  845  may audibly transmit an alarm from device  805 . In some cases, the speaker  845  may audibly transmit a multi-layer alarm having multiple layers, each associated with different layer properties, as described above with reference to  FIGS. 3 and 4A-4D . 
       FIG. 9  shows a flowchart illustrating a method  900  for multi-layer alarming in accordance with various aspects of the present disclosure. The operations of method  900  may be implemented by a device (e.g., medical device  110 , nurse station  120 , computing device  115 ), or its components as described herein. For example, the operations of method  900  may be performed by a multi-layer alarm manager as described with reference to  FIGS. 5 through 7 . In some examples, a device may execute a set of codes to control the functional elements of the device to perform the functions described below. Additionally or alternatively, the device may perform aspects the functions described below using special-purpose hardware. 
     At block  905 , the device may encode a multi-layer alarm associated with a patient. The operations of block  905  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  905  may be performed by an alarm generator as described with reference to  FIGS. 5 through 7 . 
     At block  910 , the device may encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient. The operations of block  910  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  910  may be performed by a first layer encoder as described with reference to  FIGS. 5 through 7 . 
     At block  915 , the device may encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter. The operations of block  915  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  915  may be performed by a second layer encoder as described with reference to  FIGS. 5 through 7 . 
     At block  920 , the device may audibly transmit the multi-layer alarm. The operations of block  920  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  920  may be performed by an audible transmitter as described with reference to  FIGS. 5 through 7 . 
       FIG. 10  shows a flowchart illustrating a method  1000  for multi-layer alarming in accordance with various aspects of the present disclosure. The operations of method  1000  may be implemented by a device (e.g., medical device  110 , nurse station  120 , or computing device  115 ) or its components as described herein. For example, the operations of method  1000  may be performed by a multi-layer alarm manager as described with reference to  FIGS. 5 through 7 . In some examples, a device may execute a set of codes to control the functional elements of the device to perform the functions described below. Additionally or alternatively, the device may perform aspects the functions described below using special-purpose hardware. 
     At block  1005 , the device may encode a multi-layer alarm associated with a patient. The operations of block  1005  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  1005  may be performed by an alarm generator as described with reference to  FIGS. 5 through 7 . 
     At block  1010 , the device may encode a first audible layer of the multi-layer alarm, the first audible layer identifying a severity of a measured parameter of the patient. The operations of block  1010  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  1010  may be performed by a first layer encoder as described with reference to  FIGS. 5 through 7 . 
     At block  1015 , the device may encode a second audible layer of the multi-layer alarm, the second audible layer indicating information other than the identified severity of the measured parameter. The operations of block  1015  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  1015  may be performed by a second layer encoder as described with reference to  FIGS. 5 through 7 . 
     At block  1020 , the device may encode the multi-layer alarm is based on the measured parameter crossing a threshold or a technical issue. The operations of block  1020  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  1020  may be performed by an alarm generator as described with reference to  FIGS. 5 through 7 . 
     At block  1025 , the device may audibly transmit the multi-layer alarm. The operations of block  1025  may be performed according to the methods described with reference to  FIGS. 2 through 4 . In certain examples, aspects of the operations of block  1025  may be performed by an audible transmitter as described with reference to  FIGS. 5 through 7 . 
     It should be noted that the methods described above describe possible implementations, and that the operations and the steps may be rearranged or otherwise modified and that other implementations are possible. Furthermore, aspects from two or more of the methods may be combined. 
     The description set forth herein, in connection with the appended drawings, describes example configurations and does not represent all the examples that may be implemented or that are within the scope of the claims. The term “exemplary” used herein means “serving as an example, instance, or illustration,” and not “preferred” or “advantageous over other examples.” The detailed description includes specific details for the purpose of providing an understanding of the described techniques. These techniques, however, may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form in order to avoid obscuring the concepts of the described examples. 
     In the appended figures, similar components or features may have the same reference label. Further, various components of the same type may be distinguished by following the reference label by a dash and a second label that distinguishes among the similar components. If just the first reference label is used in the specification, the description is applicable to any one of the similar components having the same first reference label irrespective of the second reference label. 
     Information and signals described herein may be represented using any of a variety of different technologies and techniques. For example, data, instructions, commands, information, signals, bits, symbols, and chips that may be referenced throughout the above description may be represented by voltages, currents, electromagnetic waves, magnetic fields or particles, optical fields or particles, or any combination thereof. 
     The various illustrative blocks and modules described in connection with the disclosure herein may be implemented or performed with a general-purpose processor, a digital signal processor (DSP), an ASIC, an field programmable gate array (FPGA) or other programmable logic device, discrete gate or transistor logic, discrete hardware components, or any combination thereof designed to perform the functions described herein. A general-purpose processor may be a microprocessor, but in the alternative, the processor may be any conventional processor, controller, microcontroller, or state machine. A processor may also be implemented as a combination of computing devices (e.g., a combination of a DSP and a microprocessor, multiple microprocessors, one or more microprocessors in conjunction with a DSP core, or any other such configuration). A processor may in some cases be in electronic communication with a memory, where the memory stores instructions that are executable by the processor. Thus, the functions described herein may be performed by one or more other processing units (or cores), on at least one integrated circuit (IC). In various examples, different types of ICs may be used (e.g., Structured/Platform ASICs, an FPGA, or another semi-custom IC), which may be programmed in any manner known in the art. The functions of each unit may also be implemented, in whole or in part, with instructions embodied in a memory, formatted to be executed by one or more general or application-specific processors. 
     The functions described herein may be implemented in hardware, software executed by a processor, firmware, or any combination thereof. If implemented in software executed by a processor, the functions may be stored on or transmitted over as one or more instructions or code on a computer-readable medium. Other examples and implementations are within the scope of the disclosure and appended claims. For example, due to the nature of software, functions described above can be implemented using software executed by a processor, hardware, firmware, hardwiring, or combinations of any of these. Features implementing functions may also be physically located at various positions, including being distributed such that portions of functions are implemented at different physical locations. Also, as used herein, including in the claims, “or” as used in a list of items (for example, a list of items prefaced by a phrase such as “at least one of” or “one or more of”) indicates an inclusive list such that, for example, a list of at least one of A, B, or C means A or B or C or AB or AC or BC or ABC (i.e., A and B and C). 
     Computer-readable media includes both non-transitory computer storage media and communication media including any medium that facilitates transfer of a computer program from one place to another. A non-transitory storage medium may be any available medium that can be accessed by a general purpose or special purpose computer. By way of example, and not limitation, non-transitory computer-readable media can comprise RAM, ROM, electrically erasable programmable read only memory (EEPROM), compact disk (CD) ROM or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other non-transitory medium that can be used to carry or store desired program code means in the form of instructions or data structures and that can be accessed by a general-purpose or special-purpose computer, or a general-purpose or special-purpose processor. Also, any connection is properly termed a computer-readable medium. For example, if the software is transmitted from a website, server, or other remote source using a coaxial cable, fiber optic cable, twisted pair, digital subscriber line (DSL), or wireless technologies such as infrared, radio, and microwave, then the coaxial cable, fiber optic cable, twisted pair, digital subscriber line (DSL), or wireless technologies such as infrared, radio, and microwave are included in the definition of medium. Disk and disc, as used herein, include CD, laser disc, optical disc, digital versatile disc (DVD), floppy disk and Blu-ray disc where disks usually reproduce data magnetically, while discs reproduce data optically with lasers. Combinations of the above are also included within the scope of computer-readable media. 
     The description herein is provided to enable a person skilled in the art to make or use the disclosure. Various modifications to the disclosure will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other variations without departing from the scope of the disclosure. Thus, the disclosure is not limited to the examples and designs described herein, but is to be accorded the broadest scope consistent with the principles and novel features disclosed herein.