A Far-View Intensive Care Unit Monitoring Display Enables Faster Triage

Abstract

Although nurses perform the majority of the clinical tasks in an intensive care unit, current patient monitors were not designed to support a nurse's workflow. Nurses constantly triage patients, deciding which patient is currently in the most need of care. To make this decision, nurses must observe the patient's vital signs and therapeutic device information from multiple sources. To obtain this information, they often have to enter the patient's room. This study addresses 3 hypotheses. Information provided by far-view monitoring displays (1) reduces the amount of time to determine which patient needs care first, (2) increases the accuracy of assigning priority to the right patient, and (3) reduces nurses mental workload. We developed 2 far-view displays to be read from a distance of 3 to 5 m without entering the patient's room. Both display vital signs, trends, alarms, infusion pump status, and therapy support indicators. To evaluate the displays, nurses were asked to use the displays to decide which of 2 patients required their attention first. They made 60 decisions: 20 with each far-view display and 20 decisions with a standard patient monitor next to an infusion pump. Sixteen nurses (median age of 27.5 years with 2.75 years of experience) participated in the study. Using the 2 far-view displays, nurses more accurately and rapidly identified stable patients and syringe pumps that were nearly empty. Median decision times were 11.3 and 12.4 seconds for the 2 far-view displays and 17.2 seconds for the control display. The 2 far-view displays reduced median decision-making times by 4.8 to 5.9 seconds, increased accuracy in assignment of priority in 2 of 7 patient conditions, and reduced nurses' frustration with the triaging task. In a clinical setting, the proposed far-view display might reduce nurses' mental workload and thereby increase patient safety.

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms

“…However, predicting an adverse event is usually more complex than the usual single-parameter alerting mechanisms in current fielded use [ 51 ]. The information needed by clinicians to understand and triage patient change is often distributed across multiple different sources [ 36 , 52 – 55 ].…”

Novel Interface Designs for Patient Monitoring Applications in Critical Care Medicine: Human Factors Review

“…Görges et al [ 24 , 25 ] described 2 integrated displays where they combined numeric values, trends, alarm status of vital signs, infusion pump information, and therapy support indicators into 1 screen. The displays were designed to support ICU nurses and doctors when they have to quickly choose which patient to treat first from a distance of 3 to 5 m. For this reason, these displays were referred to as far-view displays.…”

“…Each graph was composed of a 12-hour trend highlighting the target zone for the variable and a numeric element depicting the current value of the monitored variable. The trend element in this display is shown in Figure 19 [ 24 , 25 ].…”

“…In both the studies (2011 and 2012) [ 24 , 25 ], participants were asked to take care of 2 patients simultaneously and decide which of the 2 patients required attention first, based on the information provided on the display. In the intervention condition, participants were using the integrated displays, and in the control condition, participants were using a commercial PM (Draeger Kappa XLT PM) and 4 commercial infusion pumps.…”

Toward Designing Information Display to Support Critical Care

“…Carayon et al used direct observation to evaluate the impact of EHRs on time spent in different high-level categories of clinical tasks [19]. Other researchers have compared different approaches for organizing patient information [20,21], presenting vital signs and other bedside data [22][23][24], presenting problem lists [25], or presenting laboratory data [24,26]. Researchers have evaluated the use of computer surveillance to support identification and presentation of information around specific clinical problems, such as hospital-acquired infections [27] or ventilator-induced lung injury [28].…”