Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study

Abstract

Background Continuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms. Objective In this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers’ perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only. Methods We conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision. Results Overall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 ( P <.001) in scenario 1, and more than doubled from 3 to 8 ( P <.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 ( P <.001), and very unconfident in scenario 2 ( P= .024) with conventional monitoring. Conclusions This study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior ...

Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: a multicenter computer-based laboratory study

“…Additionally, the technology improved perceptive performance in a setting with a distraction [25]. In eye-tracking studies, we found that the technology works because users do not need to read numbers sequentially but can receive information from looking at colorful moving objects, which allows for monitoring using peripheral vision and enables parallel perception of multiple vital signs at the same time [26,27].…”

Situation Awareness-Oriented Patient Monitoring with Visual Patient Technology: A Qualitative Review of the Primary Research

“…This eye-tracking study by Pfarr et al published in 2019 [4] follows the same theoretical background as the Visual Patient series 1 eye-tracking study [3]. According to these neurophysiological principles, a person can only read glyphs when they look at them with foveal or sharp vision.…”

“…We generated empirical evidence for peripheral vision monitoring through eye-tracking studies [4]. Because of the way the avatar displays the information as colorful moving graphical objects, caregivers can monitor some of the patient's vital signs using only their peripheral field of view.…”

“…Series 1 contains the preliminary studies, which aimed at qualitative and quantitative validation, stepwise improvement, and the first comparison of the technology's performance with regular monitoring [1][2][3]. In series 2, we tested the technology in three particular conditions for patient monitoring: using only peripheral vision [4], while being distracted [6], and when monitoring multiple patients at the same time, such as is in an intensive care unit central station monitor [5]. Both study series included computer-based evaluations of monitoring scenarios by the study participants and assessment of eye-tracking data and mixed qualitative and quantitative analyses of user impressions.…”

“…In early 2020, we will begin a high-fidelity simulation study with a product by Philips (Koninklijke Philips N.V., Amsterdam, the Netherlands) developed from the Visual Patient concept. With this milestone, we move from basic research on our product [1][2][3][4][5][6][7] to clinical application research. This paper contributes a comprehensive overview of the research behind Visual Patient to the current literature.…”