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Strechen I, Herasevich S, Barwise A, Garcia-Mendez J, Rovati L, Pickering B, Diedrich D, Herasevich V. Centralized Multipatient Dashboards' Impact on Intensive Care Unit Clinician Performance and Satisfaction: A Systematic Review. Appl Clin Inform 2024; 15:414-427. [PMID: 38574763 PMCID: PMC11136527 DOI: 10.1055/a-2299-7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU) clinicians encounter frequent challenges with managing vast amounts of fragmented data while caring for multiple critically ill patients simultaneously. This may lead to increased provider cognitive load that may jeopardize patient safety. OBJECTIVES This systematic review assesses the impact of centralized multipatient dashboards on ICU clinician performance, perceptions regarding the use of these tools, and patient outcomes. METHODS A literature search was conducted on February 9, 2023, using the EBSCO CINAHL, Cochrane Central Register of Controlled Trials, Embase, IEEE Xplore, MEDLINE, Scopus, and Web of Science Core Collection databases. Eligible studies that included ICU clinicians as participants and tested the effect of dashboards designed for use by multiple users to manage multiple patients on user performance and/or satisfaction compared with the standard practice. We narratively synthesized eligible studies following the SWiM (Synthesis Without Meta-analysis) guidelines. Studies were grouped based on dashboard type and outcomes assessed. RESULTS The search yielded a total of 2,407 studies. Five studies met inclusion criteria and were included. Among these, three studies evaluated interactive displays in the ICU, one study assessed two dashboards in the pediatric ICU (PICU), and one study examined centralized monitor in the PICU. Most studies reported several positive outcomes, including reductions in data gathering time before rounds, a decrease in misrepresentations during multidisciplinary rounds, improved daily documentation compliance, faster decision-making, and user satisfaction. One study did not report any significant association. CONCLUSION The multipatient dashboards were associated with improved ICU clinician performance and were positively perceived in most of the included studies. The risk of bias was high, and the certainty of evidence was very low, due to inconsistencies, imprecision, indirectness in the outcome measure, and methodological limitations. Designing and evaluating multipatient tools using robust research methodologies is an important focus for future research.
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Affiliation(s)
- Inna Strechen
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Juan Garcia-Mendez
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Lucrezia Rovati
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Emergency Medicine, University of Milano-Bicocca, School of Medicine and Surgery, Milan, Italy
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
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Keszthelyi D, Gaudet-Blavignac C, Bjelogrlic M, Lovis C. Patient Information Summarization in Clinical Settings: Scoping Review. JMIR Med Inform 2023; 11:e44639. [PMID: 38015588 PMCID: PMC10716777 DOI: 10.2196/44639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Information overflow, a common problem in the present clinical environment, can be mitigated by summarizing clinical data. Although there are several solutions for clinical summarization, there is a lack of a complete overview of the research relevant to this field. OBJECTIVE This study aims to identify state-of-the-art solutions for clinical summarization, to analyze their capabilities, and to identify their properties. METHODS A scoping review of articles published between 2005 and 2022 was conducted. With a clinical focus, PubMed and Web of Science were queried to find an initial set of reports, later extended by articles found through a chain of citations. The included reports were analyzed to answer the questions of where, what, and how medical information is summarized; whether summarization conserves temporality, uncertainty, and medical pertinence; and how the propositions are evaluated and deployed. To answer how information is summarized, methods were compared through a new framework "collect-synthesize-communicate" referring to information gathering from data, its synthesis, and communication to the end user. RESULTS Overall, 128 articles were included, representing various medical fields. Exclusively structured data were used as input in 46.1% (59/128) of papers, text in 41.4% (53/128) of articles, and both in 10.2% (13/128) of papers. Using the proposed framework, 42.2% (54/128) of the records contributed to information collection, 27.3% (35/128) contributed to information synthesis, and 46.1% (59/128) presented solutions for summary communication. Numerous summarization approaches have been presented, including extractive (n=13) and abstractive summarization (n=19); topic modeling (n=5); summary specification (n=11); concept and relation extraction (n=30); visual design considerations (n=59); and complete pipelines (n=7) using information extraction, synthesis, and communication. Graphical displays (n=53), short texts (n=41), static reports (n=7), and problem-oriented views (n=7) were the most common types in terms of summary communication. Although temporality and uncertainty information were usually not conserved in most studies (74/128, 57.8% and 113/128, 88.3%, respectively), some studies presented solutions to treat this information. Overall, 115 (89.8%) articles showed results of an evaluation, and methods included evaluations with human participants (median 15, IQR 24 participants): measurements in experiments with human participants (n=31), real situations (n=8), and usability studies (n=28). Methods without human involvement included intrinsic evaluation (n=24), performance on a proxy (n=10), or domain-specific tasks (n=11). Overall, 11 (8.6%) reports described a system deployed in clinical settings. CONCLUSIONS The scientific literature contains many propositions for summarizing patient information but reports very few comparisons of these proposals. This work proposes to compare these algorithms through how they conserve essential aspects of clinical information and through the "collect-synthesize-communicate" framework. We found that current propositions usually address these 3 steps only partially. Moreover, they conserve and use temporality, uncertainty, and pertinent medical aspects to varying extents, and solutions are often preliminary.
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Affiliation(s)
- Daniel Keszthelyi
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Mina Bjelogrlic
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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Lunkiewicz J, Gasciauskaite G, Roche TR, Akbas S, Nöthiger CB, Ganter MT, Meybohm P, Hottenrott S, Zacharowski K, Raimann FJ, Rivas E, López-Baamonde M, Beller EA, Tscholl DW, Bergauer L. User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study. Diagnostics (Basel) 2023; 13:3391. [PMID: 37958287 PMCID: PMC10650006 DOI: 10.3390/diagnostics13213391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.
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Affiliation(s)
- Justyna Lunkiewicz
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Greta Gasciauskaite
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Tadzio Raoul Roche
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Samira Akbas
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Christoph B. Nöthiger
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Michael T. Ganter
- Institute of Anesthesiology and Critical Care Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97070 Wuerzburg, Germany; (P.M.); (S.H.)
| | - Sebastian Hottenrott
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University of Wuerzburg, 97070 Wuerzburg, Germany; (P.M.); (S.H.)
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60629 Frankfurt, Germany
| | - Florian Jürgen Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60629 Frankfurt, Germany
| | - Eva Rivas
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain; (E.R.); (M.L.-B.)
| | - Manuel López-Baamonde
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain; (E.R.); (M.L.-B.)
| | - Elisabeth Anna Beller
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - David Werner Tscholl
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
| | - Lisa Bergauer
- Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (J.L.); (T.R.R.); (S.A.); (C.B.N.); (E.A.B.)
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Andrade E, Quinlan L, Harte R, Byrne D, Fallon E, Kelly M, Casey S, Kirrane F, O'Connor P, O'Hora D, Scully M, Laffey J, Pladys P, Beuchée A, ÓLaighin G. Novel Interface Designs for Patient Monitoring Applications in Critical Care Medicine: Human Factors Review. JMIR Hum Factors 2020; 7:e15052. [PMID: 32618574 PMCID: PMC7367533 DOI: 10.2196/15052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/29/2019] [Accepted: 03/11/2020] [Indexed: 11/21/2022] Open
Abstract
Background The patient monitor (PM) is one of the most commonly used medical devices in hospitals worldwide. PMs are used to monitor patients’ vital signs in a wide variety of patient care settings, especially in critical care settings, such as intensive care units. An interesting observation is that the design of PMs has not significantly changed over the past 2 decades, with the layout and structure of PMs more or less unchanged, with incremental changes in design being made rather than transformational changes. Thus, we believe it well-timed to review the design of novel PM interfaces, with particular reference to usability and human factors. Objective This paper aims to review innovations in PM design proposed by researchers and explore how clinicians responded to these design changes. Methods A literature search of relevant databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified 16 related studies. A detailed description of the interface design and an analysis of each novel PM were carried out, including a detailed analysis of the structure of the different user interfaces, to inform future PM design. The test methodologies used to evaluate the different designs are also presented. Results Most of the studies included in this review identified some level of improvement in the clinician’s performance when using a novel display in comparison with the traditional PM. For instance, from the 16 reviewed studies, 12 studies identified an improvement in the detection and response times, and 10 studies identified an improvement in the accuracy or treatment efficiency. This indicates that novel displays have the potential to improve the clinical performance of nurses and doctors. However, the outcomes of some of these studies are weakened because of methodological deficiencies. These deficiencies are discussed in detail in this study. Conclusions More careful study design is warranted to investigate the user experience and usability of future novel PMs for real time vital sign monitoring, to establish whether or not they could be used successfully in critical care. A series of recommendations on how future novel PM designs and evaluations can be enhanced are provided.
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Affiliation(s)
- Evismar Andrade
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
| | - Leo Quinlan
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland.,Physiology, School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Richard Harte
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
| | - Dara Byrne
- General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Enda Fallon
- Mechanical Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland
| | - Martina Kelly
- Mechanical Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland
| | - Siobhan Casey
- Intensive Care Unit, University Hospital Galway, Galway, Ireland
| | | | - Paul O'Connor
- General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Denis O'Hora
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Michael Scully
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Galway, Ireland.,Department of Anaesthesia & Intensive Care Medicine, National University of Ireland, Galway, Galway, Ireland
| | - John Laffey
- Anaesthesia, School of Medicine, National University of Ireland, Galway, Galway, Ireland.,Department of Anaesthesia & Intensive Care Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Patrick Pladys
- Centre Hospitalier Universitaire de Rennes (CHU Rennes), Rennes, France.,Faculté de Médicine de l'Université de Rennes, Rennes, France
| | - Alain Beuchée
- Centre Hospitalier Universitaire de Rennes (CHU Rennes), Rennes, France.,Faculté de Médicine de l'Université de Rennes, Rennes, France
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
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5
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Wright MC, Borbolla D, Waller RG, Del Fiol G, Reese T, Nesbitt P, Segall N. Critical care information display approaches and design frameworks: A systematic review and meta-analysis. J Biomed Inform 2019; 3:100041. [PMID: 31423485 PMCID: PMC6696941 DOI: 10.1016/j.yjbinx.2019.100041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To systematically review original user evaluations of patient information displays relevant to critical care and understand the impact of design frameworks and information presentation approaches on decision-making, efficiency, workload, and preferences of clinicians. METHODS We included studies that evaluated information displays designed to support real-time care decisions in critical care or anesthesiology using simulated tasks. We searched PubMed and IEEExplore from 1/1/1990 to 6/30/2018. The search strategy was developed iteratively with calibration against known references. Inclusion screening was completed independently by two authors. Extraction of display features, design processes, and evaluation method was completed by one and verified by a second author. RESULTS Fifty-six manuscripts evaluating 32 critical care and 22 anesthesia displays were included. Primary outcome metrics included clinician accuracy and efficiency in recognizing, diagnosing, and treating problems. Implementing user-centered design (UCD) processes, especially iterative evaluation and redesign, resulted in positive impact in outcomes such as accuracy and efficiency. Innovative display approaches that led to improved human-system performance in critical care included: (1) improving the integration and organization of information, (2) improving the representation of trend information, and (3) implementing graphical approaches to make relationships between data visible. CONCLUSION Our review affirms the value of key principles of UCD. Improved information presentation can facilitate faster information interpretation and more accurate diagnoses and treatment. Improvements to information organization and support for rapid interpretation of time-based relationships between related quantitative data is warranted. Designers and developers are encouraged to involve users in formal iterative design and evaluation activities in the design of electronic health records (EHRs), clinical informatics applications, and clinical devices.
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Affiliation(s)
- Melanie C. Wright
- Trinity Health, Livonia, MI, USA
- Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Damian Borbolla
- Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | | | - Thomas Reese
- Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Paige Nesbitt
- Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Noa Segall
- Anesthesiology, Duke University, Durham, NC, USA
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Lin YL, Trbovich P, Kolodzey L, Nickel C, Guerguerian AM. Association of Data Integration Technologies With Intensive Care Clinician Performance: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e194392. [PMID: 31125104 PMCID: PMC6632132 DOI: 10.1001/jamanetworkopen.2019.4392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Sources of data in the intensive care setting are increasing exponentially, but the benefits of displaying multiparametric, high-frequency data are unknown. Decision making may not benefit from this technology if clinicians remain cognitively overburdened by poorly designed data integration and visualization technologies (DIVTs). OBJECTIVE To systematically review and summarize the published evidence on the association of user-centered DIVTs with intensive care clinician performance. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science were searched in May 2014 and January 2018. STUDY SELECTION Studies had 3 requirements: (1) the study tested a viable DIVT, (2) participants involved were intensive care clinicians, and (3) the study reported quantitative results associated with decision making in an intensive care setting. DATA EXTRACTION AND SYNTHESIS Of 252 records screened, 20 studies, published from 2004 to 2016, were included. The human factors framework to assess health technologies was applied to measure study completeness, and the Quality Assessment Instrument was used to assess the quality of the studies. PRISMA guidelines were adapted to conduct the systematic review and meta-analysis. MAIN OUTCOMES AND MEASURES Study completeness and quality; clinician performance; physical, mental, and temporal demand; effort; frustration; time to decision; and decision accuracy. RESULTS Of the 20 included studies, 16 were experimental studies with 410 intensive care clinician participants and 4 were survey-based studies with 1511 respondents. Scores for study completeness ranged from 27 to 43, with a maximum score of 47, and scores for study quality ranged from 46 to 79, with a maximum score of 90. Of 20 studies, DIVTs were evaluated in clinical settings in 2 studies (10%); time to decision was measured in 14 studies (70%); and decision accuracy was measured in 11 studies (55%). Measures of cognitive workload pooled in the meta-analysis suggested that any DIVT was an improvement over paper-based data in terms of self-reported performance, mental and temporal demand, and effort. With a maximum score of 22, median (IQR) mental demand scores for electronic display were 10 (7-13), tabular display scores were 8 (6.0-11.5), and novel visualization scores were 8 (6-12), compared with 17 (14-19) for paper. The median (IQR) temporal demand scores were also lower for all electronic visualizations compared with paper, with scores of 8 (6-11) for electronic display, 7 (6-11) for tabular and bar displays, 7 (5-11) for novel visualizations, and 16 (14.3-19.0) for paper. The median (IQR) performance scores improved for all electronic visualizations compared with paper (lower score indicates better self-reported performance), with scores of 6 (3-11) for electronic displays, 6 (4-11) for tabular and bar displays, 6 (4-11) for novel visualizations, and 14 (11-16) for paper. Frustration and physical demand domains of cognitive workload did not change, and differences between electronic displays were not significant. CONCLUSIONS AND RELEVANCE This review suggests that DIVTs are associated with increased integration and consistency of data. Much work remains to identify which visualizations effectively reduce cognitive workload to enhance decision making based on intensive care data. Standardizing human factors testing by developing a repository of open access benchmarked test protocols, using a set of outcome measures, scenarios, and data sets, may accelerate the design and selection of the most appropriate DIVT.
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Affiliation(s)
- Ying Ling Lin
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Badeau Family Research Chair in Patient Safety and Quality Improvement, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Kolodzey
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cheri Nickel
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Institute of Biomaterials and Biomedical Engineering, Faculty of Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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7
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McFarlane DC, Doig AK, Agutter JA, Brewer LM, Syroid ND, Mittu R. Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms. PLoS One 2018; 13:e0197157. [PMID: 29768477 PMCID: PMC5955574 DOI: 10.1371/journal.pone.0197157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
Objective This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. Materials and methods A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. Results Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). Discussion and conclusion Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.
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Affiliation(s)
- Daniel C. McFarlane
- Patient Care & Monitoring Solutions, Innovation Office, Royal Philips, Andover, Massachusetts, United States of America
- * E-mail:
| | - Alexa K. Doig
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - James A. Agutter
- College of Architecture & Planning, University of Utah, Salt Lake City, Utah, United States of America
- Applied Medical Visualizations (Medvis), Salt Lake City, Utah, United States of America
| | - Lara M. Brewer
- Department of Anesthesiology, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Noah D. Syroid
- Applied Medical Visualizations (Medvis), Salt Lake City, Utah, United States of America
- Anesthesiology Center for Patient Simulation, University of Utah, Salt Lake City, Utah, United States of America
| | - Ranjeev Mittu
- Information Technology Division, Information Management and Decision Architectures Branch, United States Naval Research Laboratory, Washington, District of Columbia, United States of America
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8
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Halpern NA. Innovative Designs for the Smart ICU. Chest 2017; 145:646-658. [PMID: 27845639 DOI: 10.1378/chest.13-0004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 10/28/2013] [Indexed: 11/01/2022] Open
Abstract
Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU can be conceptualized into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including its infrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated computers, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room, on-call suite, conference rooms, and offices), and the universal support services (infection prevention, finishings and flooring, staff communications, signage and wayfinding, security, and fire and safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. A balanced approach to centralized and decentralized monitoring and logistics also offers great flexibility. Synchronization of the universal support services in the ICU with the hospital's existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center; and Weill Cornell Medical College, New York, NY.
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Lin YL, Guerguerian AM, Tomasi J, Laussen P, Trbovich P. "Usability of data integration and visualization software for multidisciplinary pediatric intensive care: a human factors approach to assessing technology". BMC Med Inform Decis Mak 2017; 17:122. [PMID: 28806954 PMCID: PMC5557066 DOI: 10.1186/s12911-017-0520-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/04/2017] [Indexed: 11/17/2022] Open
Abstract
Background Intensive care clinicians use several sources of data in order to inform decision-making. We set out to evaluate a new interactive data integration platform called T3™ made available for pediatric intensive care. Three primary functions are supported: tracking of physiologic signals, displaying trajectory, and triggering decisions, by highlighting data or estimating risk of patient instability. We designed a human factors study to identify interface usability issues, to measure ease of use, and to describe interface features that may enable or hinder clinical tasks. Methods Twenty-two participants, consisting of bedside intensive care physicians, nurses, and respiratory therapists, tested the T3™ interface in a simulation laboratory setting. Twenty tasks were performed with a true-to-setting, fully functional, prototype, populated with physiological and therapeutic intervention patient data. Primary data visualization was time series and secondary visualizations were: 1) shading out-of-target values, 2) mini-trends with exaggerated maxima and minima (sparklines), and 3) bar graph of a 16-parameter indicator. Task completion was video recorded and assessed using a use error rating scale. Usability issues were classified in the context of task and type of clinician. A severity rating scale was used to rate potential clinical impact of usability issues. Results Time series supported tracking a single parameter but partially supported determining patient trajectory using multiple parameters. Visual pattern overload was observed with multiple parameter data streams. Automated data processing using shading and sparklines was often ignored but the 16-parameter data reduction algorithm, displayed as a persistent bar graph, was visually intuitive. However, by selecting or automatically processing data, triggering aids distorted the raw data that clinicians use regularly. Consequently, clinicians could not rely on new data representations because they did not know how they were established or derived. Conclusions Usability issues, observed through contextual use, provided directions for tangible design improvements of data integration software that may lessen use errors and promote safe use. Data-driven decision making can benefit from iterative interface redesign involving clinician-users in simulated environments. This study is a first step in understanding how software can support clinicians’ decision making with integrated continuous monitoring data. Importantly, testing of similar platforms by all the different disciplines who may become clinician users is a fundamental step necessary to understand the impact on clinical outcomes of decision aids. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0520-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Ling Lin
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building (RS), 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada.,Department of Critical Care Medicine, The Hospital for Sick Children, Canada, 555 University Ave., 2nd Floor, Atrium - Room 2830A, Toronto, ON, M5G 1X8, Canada
| | - Anne-Marie Guerguerian
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building (RS), 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada.,Department of Critical Care Medicine, The Hospital for Sick Children, Canada, 555 University Ave., 2nd Floor, Atrium - Room 2830A, Toronto, ON, M5G 1X8, Canada.,Neurosciences and Mental Health Research, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research & Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Jessica Tomasi
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building (RS), 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada
| | - Peter Laussen
- Department of Critical Care Medicine, The Hospital for Sick Children, Canada, 555 University Ave., 2nd Floor, Atrium - Room 2830A, Toronto, ON, M5G 1X8, Canada
| | - Patricia Trbovich
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building (RS), 164 College Street, Room 407, Toronto, ON, M5S 3G9, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Suite 425, Toronto, ON, M5T 3M6, Canada. .,Research and Innovation, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada.
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Wright MC, Dunbar S, Macpherson BC, Moretti EW, Del Fiol G, Bolte J, Taekman JM, Segall N. Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort. Appl Clin Inform 2016; 7:912-929. [PMID: 27704138 PMCID: PMC5228134 DOI: 10.4338/aci-2016-03-ra-0033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information. METHODS We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians' information use activities in critical care settings. We played video recordings back to clinicians in retrospective cued interviews and queried: 1) context and goals of information use, 2) impacts of current display design on use, and 3) processes related to information use. We analyzed interview transcripts using grounded theory-based content analysis techniques and identified emerging themes. From these, we conducted a visioning activity with a team of subject matter experts and identified key areas for focus of design and research for future display designs. RESULTS Analyses revealed four unique critical care information use activities including new patient assessment, known patient status review, specific directed information seeking, and review and prioritization of multiple patients. Emerging themes were primarily related to a need for better representation of dynamic data such as vital signs and laboratory results, usability issues associated with reducing cognitive load and supporting efficient interaction, and processes for managing information. Visions for the future included designs that: 1) provide rapid access to new information, 2) organize by systems or problems as well as by current versus historical patient data, and 3) apply intelligence toward detecting and representing change and urgency. CONCLUSIONS The results from this study can be used to guide the design of future acute care electronic health information display. Additional research and collaboration is needed to refine and implement intelligent graphical user interfaces to improve clinical information organization and prioritization to support care decisions.
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Affiliation(s)
- Melanie C Wright
- Melanie C. Wright, PhD, Program Director, Patient Safety Research, Trinity Health and Saint Alphonsus Health System, 1055 N. Curtis Rd, Boise ID 83702, , Phone: 208-367-7399
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Abstract
This third and final installment of this series on innovative designs for the smart ICU addresses the steps involved in conceptualizing, actualizing, using, and maintaining the advanced ICU informatics infrastructure and systems. The smart ICU comprehensively and electronically integrates the patient in the ICU with all aspects of care, displays data in a variety of formats, converts data to actionable information, uses data proactively to enhance patient safety, and monitors the ICU environment to facilitate patient care and ICU management. The keys to success in this complex informatics design process include an understanding of advanced informatics concepts, sophisticated planning, installation of a robust infrastructure capable of both connectivity and interoperability, and implementation of middleware solutions that provide value. Although new technologies commonly appear compelling, they are also complicated and challenging to incorporate within existing or evolving hospital informatics systems. Therefore, careful analysis, deliberate testing, and a phased approach to the implementation of innovative technologies are necessary to achieve the multilevel solutions of the smart ICU.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center; and Weill Cornell Medical College, New York, NY.
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Koch SH, Weir C, Westenskow D, Gondan M, Agutter J, Haar M, Liu D, Görges M, Staggers N. Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: A prospective randomized controlled study. Int J Med Inform 2013; 82:665-75. [PMID: 23357614 DOI: 10.1016/j.ijmedinf.2012.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The study measured whether nurses' situation awareness would increase and task completion time decrease when they used an integrated information display compared to traditional displays for medication management, patient awareness and team communication. SETTING The Burn Trauma Intensive Care Unit (BTICU) at the University Hospital, University of Utah Health Science Center, Salt Lake City, Utah, USA. PARTICIPANTS 12 experienced BTICU nurses. MEASURES Situation awareness (accuracy of the participants' answer) and task completion time (response time from seeing the question to submitting the answer) were measured using paper prototypes of both displays. STUDY DESIGN Counter-balanced (on display order), repeated-measures design. MAIN RESULTS Nurses had a higher situation awareness when using the integrated display, with an overall accuracy of 85.3% compared to 61.8% with the traditional displays (odds ratio 3.61, P<.001, 95% CI=2.34…5.57). Task completion times were nearly half with integrated displays compared to traditional displays (median 26.0 and 42.1s, hazard ratio 2.31, P<.001, CI=1.83…2.93). CONCLUSIONS An integrated ICU information display increased nurses' situation awareness and decreased task completion time. Information integration has the potential to decrease errors, increase nurses' productivity and may allow nurses to react faster to a patient's clinical needs. Bidirectional device communication is needed for these displays to achieve full potential in improving patient safety.
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Affiliation(s)
- Sven H Koch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.
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Görges M, Westenskow DR, Markewitz BA. Evaluation of an integrated intensive care unit monitoring display by critical care fellow physicians. J Clin Monit Comput 2012; 26:429-36. [PMID: 22588528 DOI: 10.1007/s10877-012-9370-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 05/02/2012] [Indexed: 11/28/2022]
Abstract
In the past two far-view displays, which showed vital signs, trends, alarms, infusion pump status, and therapy support indicators, were developed and assessed by critical care nurses (Görges et al. in Dimens Crit Care Nurs. 30(4):206-17, 2011). The aim of the current study is to assess the generalizability of these findings to physicians. The first aim is to test whether an integrated far-view display, designed to be readable from 3 to 5 m, enables critical care physicians to more rapidly and accurately (1) recognize a change in patient condition; (2) identify alarms; and (3) identify near-empty infusion pumps, than a traditional patient monitor and infusion pump. A second aim is to test if the new displays reduce the mental workload required for this decision making. Fifteen critical care fellow physicians (median age of 34 years, with 2-8 years of ICU experience) were asked to use the three displays to compare the data from two patients and decide which patient required their attention first. Each physician made 60 decisions: 20 with each of the two far-view displays and 20 decisions with a standard patient monitor next to an infusion pump. A 41 and 26 % improvement in decision accuracy was observed with the bar and clock far-view displays, respectively. Specifically, the identification of near empty infusion pumps, a task normally performed by nurses, and patients with a single alarm were better with the new displays. Using the bar display physicians made their decision 12 % faster than when using the control display, a median improvement of 2.1 s. No significant differences were observed in measured workload. Displays that present patient data in a redesigned format enables critical care clinicians to more rapidly identify changes in patient conditions and to more accurately decide which patient needs their attention. In a clinical setting, this could improve patient safety. In future work, an evaluation of the display using live patient data from an ICU should be performed.
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Affiliation(s)
- Matthias Görges
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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