Frequency and Type of Situational Awareness Errors Contributing to Death and Brain Damage

BMC Med Inform Decis Mak

Pfarr

et al. 2020

Background: Maintaining adequate situation awareness is crucial for patient safety. Previous studies found that the use of avatar-based monitoring (Visual Patient Technology) improved the perception of vital signs compared to conventional monitoring showing numerical and waveform data; and was further associated with a reduction of perceived workload. In this study, we aimed to evaluate the effectiveness of Visual Patient Technology on perceptive performance and perceived workload when monitoring multiple patients at the same time, such as in central station monitors in intensive care units or operating rooms. Methods: A prospective, within-subject, computer-based laboratory study was performed in two tertiary care hospitals in Switzerland in 2018. Thirty-eight physician and nurse anesthetists volunteered for the study. The participants were shown four different central monitor scenarios in sequence, where each scenario displayed two critical and four healthy patients simultaneously for 10 or 30 s. After each scenario, participants had to recall the vital signs of the critical patients. Perceived workload was assessed with the National Aeronautics and Space Administration Task-Load-Index (NASA TLX) questionnaire. Results: In the 10-s scenarios, the median number of remembered vital signs significantly improved from 7 to 11 using avatar-based versus conventional monitoring with a mean of differences of 4 vital signs, 95% confidence interval (CI) 2 to 6, p < 0.001. At the same time, the median NASA TLX scores were significantly lower for avatarbased monitoring (67 vs. 77) with a mean of differences of 6 points, 95% CI 0.5 to 11, p = 0.034. In the 30-s scenarios, vital sign perception and workload did not differ significantly. Conclusions: In central monitor multiple patient monitoring, we found a significant improvement of vital sign perception and reduction of perceived workload using Visual Patient Technology, compared to conventional monitoring. The technology enabled improved assessment of patient status and may, thereby, help to increase situation awareness and enhance patient safety.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Garot

BMC Med Inform Decis Mak

Pfarr

et al. 2020

“…The first level of situation awareness is the perception of environmental elements; for example, in the setting of anesthesia that corresponds to noticing the status and dynamics of the patient's vital signs on the monitor. Research has found up to 80% of anesthesia adverse events result from a lack of situation awareness, with level 1 errors (perception) accounting for the largest share (42%) [12,13]. The second and third levels of situation awareness are the comprehension of these perceived elements and their projected course.…”

Section: Situation Awarenessmentioning

confidence: 99%

“…We measured information perception (first level of situation awareness) because most human errors are due to situation awareness level 1 errors, in which available information is unrecognized [8,12,13]. This fact underscores the dire need for information tools that are simpler to interpret.…”

Section: Vital Sign Perceptionmentioning

confidence: 99%

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

Tscholl

Said

et al. 2020

Sensors

Visual Patient technology is a situation awareness-oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements-a language humans can easily perceive and interpret-on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.

“…There is still much room for improvement in patient monitoring systems and, based on previous research, we claim that standardization, 31 easy understanding, [3][4][5][6][7][8][9][10] and fatigue prevention [32][33][34][35] should be sought after to reduce the risk of accidents to happen and improve patient safety and operator well-being. Policy makers and creators of patient monitors should feel encouraged to satisfy these areas.…”

Section: -30mentioning

confidence: 99%

It’s not you, it’s the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study.

Tscholl

Handschin

et al. 2019

Preprint

BACKGROUND Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions of the information displayed on patient monitors. Research has shown that today's patient monitoring provides room for improvement regarding known issues such as information overload and alarm fatigue. The rationale for this study was to learn more about the problems anesthesiologists face with patient monitors and to provide improvement suggestions for next-generation patient monitoring. METHODS We conducted a two-center qualitative and quantitative study. First, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: "Common problems with patient monitoring in your daily work." Through deductive and inductive coding, we identified themes and subthemes from the interviews. Secondly, we conducted a field survey with a separate group of 25 anesthesiologists who rated their agree- or disagreement with central statements based on the themes identified from the interviews. RESULTS We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub-topics. The central statements based on each major theme were: 1. “problems with alarm settings complicate the work with patient monitoring.” (96% agreed) 2. “artifacts complicate the assessment of the patient's condition.” (56% agreed) 3. “information overload makes it difficult to get a quick overview of the situation.” (56% agreed) 4. “problems with cables make working with patient monitors tedious.” (88% agreed) 5. “factors related to human performance lead to patient conditions not being perceived on the monitor.” (64% agreed) 6. “Insufficient standardization: Switching back and forth between monitors from different manufacturers makes it difficult to work with patient monitors.” (88% agreed). All statements differed significantly from the neutral opinion. CONCLUSION This study provides an overview of the problems anesthesiologists face with patient monitoring. Some of the issues identified were previously less known, such as problems with monitor cables (e.g., entanglement and worn connectors), human factors (e.g., fatigue and distractions), and systemic factors (e.g., insufficient standardization between manufacturers). According to our findings, an ideal monitor should reduce false positive alarms to a minimum, use as few cables as possible, and be easy to interpret.