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Clarke H, Leav S, Zestic J, Mohamed I, Salisbury I, Sanderson P. Enhanced Neonatal Pulse Oximetry Sounds for the First Minutes of Life: A Laboratory Trial. HUMAN FACTORS 2024; 66:1017-1036. [PMID: 35993422 DOI: 10.1177/00187208221118472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Auditory enhancements to the pulse oximetry tone may help clinicians detect deviations from target ranges for oxygen saturation (SpO2) and heart rate (HR). BACKGROUND Clinical guidelines recommend target ranges for SpO2 and HR during neonatal resuscitation in the first 10 minutes after birth. The pulse oximeter currently maps HR to tone rate, and SpO2 to tone pitch. However, deviations from target ranges for SpO2 and HR are not easy to detect. METHOD Forty-one participants were presented with 30-second simulated scenarios of an infant's SpO2 and HR levels in the first minutes after birth. Tremolo marked distinct HR ranges and formants marked distinct SpO2 ranges. Participants were randomly allocated to conditions: (a) No Enhancement control, (b) Enhanced HR Only, (c) Enhanced SpO2 Only, and (d) Enhanced Both. RESULTS Participants in the Enhanced HR Only and Enhanced SpO2 Only conditions identified HR and SpO2 ranges, respectively, more accurately than participants in the No Enhancement condition, ps < 0.001. In the Enhanced Both condition, the tremolo enhancement of HR did not affect participants' ability to identify SpO2 range, but the formants enhancement of SpO2 may have attenuated participants' ability to identify tremolo-enhanced HR range. CONCLUSION Tremolo and formant enhancements improve range identification for HR and SpO2, respectively, and could improve clinicians' ability to identify SpO2 and HR ranges in the first minutes after birth. APPLICATION Enhancements to the pulse oximeter tone to indicate clinically important ranges could improve the management of oxygen delivery to the neonate during resuscitation in the first 10 minutes after birth.
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Affiliation(s)
- Hugh Clarke
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Samnang Leav
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Jelena Zestic
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Ismail Mohamed
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Isaac Salisbury
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Penelope Sanderson
- School of Psychology
- School of Information Technology and Electrical Engineering, and
- School of Clinical Medicine, The University of Queensland, St Lucia, QLD, Australia
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Neary A, Li SYW, Salisbury I, Loeb RG, Sanderson PM. Effects of multitasking on interpreting a spearcon sequence display for monitoring multiple patients. APPLIED ERGONOMICS 2023; 112:104072. [PMID: 37327694 DOI: 10.1016/j.apergo.2023.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/27/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
Spearcons are time-compressed speech phrases. When arranged in a sequence representing vital signs of multiple patients, spearcons may be more informative than conventional auditory alarms. However, multiple resource theory suggests that certain timeshared tasks might interfere with listeners' ability to understand spearcons. We tested the relative interference with spearcon identification from the following ongoing tasks: (1) manual tracking, (2) linguistic detection of spoken target words, (3) arithmetic true-false judgments, or (4) an ignored background speech control. Participants were 80 non-clinicians. The linguistic task worsened spearcon identification more than the tracking task, p < .001, and more than ignored background speech, p = .012. The arithmetic task worsened spearcon identification more than the tracking task, p < .001. The linguistic task and arithmetic task both worsened performance, p = .674. However, no ongoing task affected participants' ability to detect which patient(s) in a sequence had abnormal vital signs. Future research could investigate whether timeshared tasks affect non-speech auditory alerts.
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Affiliation(s)
- Alexandra Neary
- School of Psychology, The University of Queensland, Australia
| | - Simon Y W Li
- School of Psychological Science, The University of Western Australia, Australia
| | - Isaac Salisbury
- School of Psychology, The University of Queensland, Australia
| | - Robert G Loeb
- School of Psychology, The University of Queensland, Australia; Department of Anesthesiology, University of Florida School of Medicine, Gainesville, USA
| | - Penelope M Sanderson
- School of Psychology, The University of Queensland, Australia; School of Clinical Medicine, The University of Queensland, Australia.
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Hinckfuss K, Sanderson PM, Brecknell B, Loeb RG, Liu D, Liley H. Evaluating enhanced pulse oximetry auditory displays for neonatal oxygen targeting: A randomized laboratory trial with clinicians and non-clinicians. APPLIED ERGONOMICS 2023; 107:103918. [PMID: 36395550 DOI: 10.1016/j.apergo.2022.103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Standard pulse oximeter auditory tones do not clearly indicate departures from the target range of oxygen saturation (SpO2) of 90%-95% in preterm neonates. We tested whether acoustically enhanced tones would improve participants' ability to identify SpO2 range. Twenty-one clinicians and 23 non-clinicians used (1) standard pulse oximetry variable-pitch tones plus alarms; (2) beacon-enhanced tones without alarms in which reference tones were inserted before standard pulse tones when SpO2 was outside target range; and (3) tremolo-enhanced tones without alarms in which pulse tones were modified with tremolo when SpO2 was outside target range. For clinicians, range identification accuracies (mean (SD)) in the standard, beacon, and tremolo conditions were 52% (16%), 73% (14%) and 76% (13%) respectively, and for non-clinicians 49% (16%), 76% (13%) and 72% (14%) respectively, with enhanced conditions always significantly more accurate than standard. Acoustic enhancements to pulse oximetry clearly indicate departures from preterm neonates' target SpO2 range.
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Affiliation(s)
- Kelly Hinckfuss
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Penelope M Sanderson
- Schools of Psychology, Clinical Medicine, and ITEE, The University of Queensland, Brisbane, Australia.
| | - Birgit Brecknell
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Robert G Loeb
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - David Liu
- Sunshine Coast University Hospital, Queensland, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Helen Liley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Sanderson PM, Loeb RG, Liley H, Liu D, Paterson E, Hinckfuss K, Zestic J. Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones. Biomed Instrum Technol 2022; 56:46-57. [PMID: 35671368 PMCID: PMC9767428 DOI: 10.2345/0899-8205-56.2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.
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Affiliation(s)
- Penelope M Sanderson
- Penelope M. Sanderson, PhD, is professor of cognitive engineering and human factors in the Schools of Psychology, Clinical Medicine, and Information Technology and Electrical Engineering at The University of Queensland in Queensland, Australia.
| | - Robert G Loeb
- Robert G. Loeb, MD, is an honorary professor in the School of Psychology at The University of Queensland in Queensland, Australia, and an emeritus clinical professor at University of Florida-Gainesville
| | - Helen Liley
- Helen Liley, MBCh, FRACP, is a senior staff specialist at Mater Mothers' Hospital and a professor in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - David Liu
- David Liu, MBBS, PhD, is an anaesthetics registrar at Sunshine Coast University Hospital in Queensland, Australia, and a senior lecturer in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - Estrella Paterson
- Estrella Paterson, PhD, is a postdoctoral fellow in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Kelly Hinckfuss
- Kelly Hinckfuss, MPhil, is a clinical masters student in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Jelena Zestic
- Jelena Zestic, PhD, is a human systems engineer at Boeing Research and Technology in Brisbane, Australia
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Sanderson PM, Loeb RG, Liley H, Liu D, Paterson E, Hinckfuss K, Zestic J. Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones. Biomed Instrum Technol 2022. [PMID: 35671368 DOI: 10.2345/1943-5967-56.2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.
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Affiliation(s)
- Penelope M Sanderson
- Penelope M. Sanderson, PhD, is professor of cognitive engineering and human factors in the Schools of Psychology, Clinical Medicine, and Information Technology and Electrical Engineering at The University of Queensland in Queensland, Australia.
| | - Robert G Loeb
- Robert G. Loeb, MD, is an honorary professor in the School of Psychology at The University of Queensland in Queensland, Australia, and an emeritus clinical professor at University of Florida-Gainesville
| | - Helen Liley
- Helen Liley, MBCh, FRACP, is a senior staff specialist at Mater Mothers' Hospital and a professor in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - David Liu
- David Liu, MBBS, PhD, is an anaesthetics registrar at Sunshine Coast University Hospital in Queensland, Australia, and a senior lecturer in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - Estrella Paterson
- Estrella Paterson, PhD, is a postdoctoral fellow in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Kelly Hinckfuss
- Kelly Hinckfuss, MPhil, is a clinical masters student in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Jelena Zestic
- Jelena Zestic, PhD, is a human systems engineer at Boeing Research and Technology in Brisbane, Australia
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Liley HG, Zestic J. Reaching for improvement in newborn resuscitation. Resuscitation 2021; 167:407-409. [PMID: 34400270 DOI: 10.1016/j.resuscitation.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Helen G Liley
- Faculty of Medicine and Mater Research, The University of Queensland, Australia.
| | - Jelena Zestic
- School of Psychology, Cognitive Engineering Research Group, The University of Queensland, Australia
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Paterson E, Sanderson PM, Salisbury IS, Burgmann FP, Mohamed I, Loeb RG, Paterson NA. Evaluation of an enhanced pulse oximeter auditory display: a simulation study. Br J Anaesth 2020; 125:826-834. [DOI: 10.1016/j.bja.2020.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 10/23/2022] Open
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Defining information needs in neonatal resuscitation with work domain analysis. J Clin Monit Comput 2020; 35:689-710. [PMID: 32458169 DOI: 10.1007/s10877-020-00526-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To gain a deeper understanding of the information requirements of clinicians conducting neonatal resuscitation in the first 10 min after birth. BACKGROUND During the resuscitation of a newborn infant in the first minutes after birth, clinicians must monitor crucial physiological adjustments that are relatively unobservable, unpredictable, and highly variable. Clinicians' access to information regarding the physiological status of the infant is also crucial to determining which interventions are most appropriate. To design displays to support clinicians during newborn resuscitation, we must first carefully consider the information requirements. METHODS We conducted a work domain analysis (WDA) for the neonatal transition in the first 10 min after birth. We split the work domain into two 'subdomains'; the physiology of the neonatal transition, and the clinical resources supporting the neonatal transition. A WDA can reveal information requirements that are not yet supported by resources. RESULTS The physiological WDA acted as a conceptual tool to model the exact processes and functions that clinicians must monitor and potentially support during the neonatal transition. Importantly, the clinical resources WDA revealed several capabilities and limitations of the physical objects in the work domain-ultimately revealing which physiological functions currently have no existing sensor to provide clinicians with information regarding their status. CONCLUSION We propose two potential approaches to improving the clinician's information environment: (1) developing new sensors for the information we lack, and (2) employing principles of ecological interface design to present currently available information to the clinician in a more effective way.
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Collett R, Salisbury I, Loeb RG, Sanderson PM. Smooth or Stepped? Laboratory Comparison of Enhanced Sonifications for Monitoring Patient Oxygen Saturation. HUMAN FACTORS 2020; 62:124-137. [PMID: 31180734 DOI: 10.1177/0018720819845742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The pulse oximeter (PO) provides anesthesiologists with continuous visual and auditory information about a patient's oxygen saturation (SpO2). However, anesthesiologists' attention is often diverted from visual displays, and clinicians may inaccurately judge SpO2 values when relying on conventional PO auditory tones. We tested whether participants could identify SpO2 value (e.g., "97%") better with acoustic enhancements that identified three discrete clinical ranges by either changing abruptly at two threshold values (stepped-effects) or changing incrementally with each percentage value of SpO2 (smooth-effects). METHOD In all, 79 nonclinicians participated in a between-subjects experiment that compared performance of participants using the stepped-effects display with those who used the smooth-effects display. In both conditions, participants heard sequences of 72 tones whose pitch directly correlated to SpO2 value, and whose value could change incrementally. Primary outcome was percentage of responses that correctly identified the absolute SpO2 percentage, ±1, of the last pulse tone in each sequence. RESULTS Participants using the stepped-effects auditory tones identified absolute SpO2 percentage more accurately (M = 53.7%) than participants using the smooth-effects tones (M = 47.9%, p = .038). Identification of range and detection of transitions between ranges showed even stronger advantages for the stepped-effects display (p < .005). CONCLUSION The stepped-effects display has more pronounced auditory cues at SpO2 range transitions, from which participants can better infer absolute SpO2 values. Further development of a smooth-effects display for this purpose is not necessary.
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Liley HG, Zestic J. The beating heart of newborn resuscitation. Resuscitation 2019; 143:223-224. [PMID: 31430513 DOI: 10.1016/j.resuscitation.2019.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Helen G Liley
- Faculty of Medicine and Mater Research, The University of Queensland, Australia.
| | - Jelena Zestic
- School of Psychology, Cognitive Engineering Research Group, The University of Queensland, Australia
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