Supporting multiple patient monitoring with head-worn displays and spearcons

Attention to Changes on a Head-Worn Display: Two Preclinical Studies with Healthcare Scenarios

OBJECTIVE

In two experiments, we examined how quickly different visual alerts on a head-worn display (HWD) would capture participants' attention to a matrix of patient vital sign values, while multitasking.

BACKGROUND

An HWD could help clinicians monitor multiple patients, regardless of where the clinician is located. We sought effective ways for HWDs to alert multitasking wearers to important events.

METHODS

In two preclinical experiments, university student participants performed a visuomotor tracking task while simultaneously monitoring simulated patient vital signs on an HWD to detect abnormal values. Methods to attract attention to abnormal values included highlighting abnormal vital signs and imposing a white flash over the entire display.

RESULTS

Experiment 1 found that participants detected abnormal values faster with high contrast than low contrast greyscale highlights, even while performing difficult tracking. In Experiment 2, a white flash of the entire screen quickly and reliably captured attention to vital signs, but less so on an HWD than on a conventional screen.

CONCLUSION

Visual alerts on HWDs can direct users' attention to patient transition events (PTEs) even under high visual-perceptual load, but not as quickly as visual alerts on fixed displays. Aspects of the results have since been tested in a healthcare context.

APPLICATION

Potential applications include informing the design of HWD interfaces for monitoring multiple processes and informing future research on capturing attention to HWDs.

A Spatiotemporal and Multisensory Approach to Designing Wearable Clinical ICU Alarms

In health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts clinicians attending to multiple concurrent tasks. However, the volume, design, and pervasiveness of existing Intensive Care Unit (ICU) alarms can make it difficult to quickly distinguish their meaning and importance. In this study, we evaluated the effectiveness of two design approaches not yet explored in a smartwatch-based alarm system designed for ICU use: (1) using audiovisual spatial colocalization and (2) adding haptic (i.e., touch) information. We compared the performance of 30 study participants using ICU smartwatch alarms containing auditory icons in two implementations of the audio modality: colocalized with the visual cue on the smartwatch's low-quality speaker versus delivered from a higher quality speaker located two feet away from participants (like a stationary alarm bay situated near patients in the ICU). Additionally, we compared participant performance using alarms with two sensory modalities (visual and audio) against alarms with three sensory modalities (adding haptic cues). Participants were 10.1% (0.24s) faster at responding to alarms when auditory information was delivered from the smartwatch instead of the higher quality external speaker. Meanwhile, adding haptic information to alarms improved response times to alarms by 12.2% (0.23s) and response times on their primary task by 10.3% (0.08s). Participants rated learnability and ease of use higher for alarms with haptic information. These small but statistically significant improvements demonstrate that audiovisual colocalization and multisensory alarm design can improve user response times.

Effects of multitasking on interpreting a spearcon sequence display for monitoring multiple patients

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.

Applications of Smart Glasses in Applied Sciences: A Systematic Review

The aim of this study is to review academic papers on the applications of smart glasses. Among 82 surveyed papers, 57 were selected through filtering. The papers were published from January 2014 to October 2020. Four research questions were set up using the systematic review method, and conclusions were drawn focusing on the research trends by year and application fields; product and operating system; sensors depending on the application purpose; and data visualization, processing, and transfer methods. It was found that the most popular commercial smart glass products are Android-based Google products. In addition, smart glasses are most often used in the healthcare field, particularly for clinical and surgical assistance or for assisting mentally or physically disabled persons. For visual data transfer, 90% of the studies conducted used a camera sensor. Smart glasses have mainly been used to visualize data based on augmented reality, in contrast with the use of mixed reality. The results of this review indicate that research related to smart glasses is steadily increasing, and technological research into the development of smart glasses is being actively conducted.

Augmenting Critical Care Patient Monitoring Using Wearable Technology: Review of Usability and Human Factors

Background

Continuous monitoring of the vital signs of critical care patients is an essential component of critical care medicine. For this task, clinicians use a patient monitor (PM), which conveys patient vital sign data through a screen and an auditory alarm system. Some limitations with PMs have been identified in the literature, such as the need for visual contact with the PM screen, which could result in reduced focus on the patient in specific scenarios, and the amount of noise generated by the PM alarm system. With the advancement of material science and electronic technology, wearable devices have emerged as a potential solution for these problems. This review presents the findings of several studies that focused on the usability and human factors of wearable devices designed for use in critical care patient monitoring.

Objective

The aim of this study is to review the current state of the art in wearable devices intended for use by clinicians to monitor vital signs of critical care patients in hospital settings, with a focus on the usability and human factors of the devices.

Methods

A comprehensive literature search of relevant databases was conducted, and 20 studies were identified and critically reviewed by the authors.

Results

We identified 3 types of wearable devices: tactile, head-mounted, and smartwatch displays. In most cases, these devices were intended for use by anesthesiologists, but nurses and surgeons were also identified as potentially important users of wearable technology in critical care medicine. Although the studies investigating tactile displays revealed their potential to improve clinical monitoring, usability problems related to comfort need to be overcome before they can be considered suitable for use in clinical practice. Only a few studies investigated the usability and human factors of tactile displays by conducting user testing involving critical care professionals. The studies of head-mounted displays (HMDs) revealed that these devices could be useful in critical care medicine, particularly from an ergonomics point of view. By reducing the amount of time the user spends averting their gaze from the patient to a separate screen, HMDs enable clinicians to improve their patient focus and reduce the potential of repetitive strain injury.

Conclusions

Researchers and designers of new wearable devices for use in critical care medicine should strive to achieve not only enhanced performance but also enhanced user experience for their users, especially in terms of comfort and ease of use. These aspects of wearable displays must be extensively tested with the intended end users in a setting that properly reflects the intended context of use before their adoption can be considered in clinical settings.

Head-worn displays and job content: A systematic literature review

Despite the emergence of head-worn displays at work around forty years ago, few studies have appeared about their impact on job content. To investigate this, a systematic literature review was conducted on these devices and job content, defined as job demands and controls. In total, 3481 studies were identified using five scientific databases. After applying selection criteria, reference searches, citation tracking and an in-depth reading, 28 studies were selected for review. Remarkably, the findings of these studies showed contrasting results. Both increases and decreases in job demands and controls were identified. We distinguished across studies two opposite approaches for the deployment of these devices, i.e. a supportive and a directive approach.

The impact of concurrent linguistic tasks on participants' identification of spearcons

Spearcons (time-compressed speech) may be a viable auditory display for patient monitoring; however, the impact of concurrent linguistic tasks remains unexamined. We tested whether different concurrent linguistic tasks worsen participants' identification of spearcons. Experiment 1 tested non-clinician participants' identification of multiple-patient spearcons representing 2 vital signs of 5 patients while participants performed no concurrent task, reading, or saying linguistic tasks. Experiment 2 tested non-clinician participants' identification of 48 single-patient spearcons while they performed no concurrent task, reading, listening, and saying linguistic tasks. In Experiment 1 the saying task worsened participants' identification of spearcons compared with no concurrent task or reading. In Experiment 2, the saying and listening tasks reduced participants' accuracy at identifying spearcons, but the reading task did not. Listening affected identification accuracy no differently than the saying task did. Concurrent auditory linguistic tasks worsen participants' identification of spearcons, probably due to auditory modality interference in verbal working memory.

Impacts of Wearable Augmented Reality Displays on operator performance, Situation Awareness, and communication in safety-critical systems

Wearable Augmented Reality Displays (WARDs) present situated, real-time information visually, providing immediate access to information to support decision making. The impacts of WARD use on operator performance, Situation Awareness (SA), and communication in one safety-critical system, marine transportation, were examined in a real-time physical simulator. WARD use improved operator trackkeeping performance, the practice of good seamanship, and SA, although operator responsiveness decreased. WARD users who used more closed-loop communication and information sharing showed improved threat avoidance, suggesting that operators can avoid accidents and failure through WARD use that promotes sharing and confirming information. WARD use also promoted information source diversity, a means of developing requisite variety. These operational impacts are important in safety-critical settings where failures can be catastrophic.