Monitoring vital signs with time-compressed speech.

Abstract

Spearcons—time-compressed speech phrases—may be an effective way of communicating vital signs to clinicians without disturbing patients and their families. Four experiments tested the effectiveness of spearcons for conveying oxygen saturation (SpO2) and heart rate (HR) of one or more patients. Experiment 1 demonstrated that spearcons were more effective than earcons (abstract auditory motifs) at conveying clinical ranges. Experiment 2 demonstrated that casual listeners could not learn to decipher the spearcons whereas listeners told the exact vocabulary could. Experiment 3 demonstrated that participants could interpret sequences of sounds representing multiple patients better with spearcons than with pitch-based earcons, especially when tones replaced the spearcons for normal patients. Experiment 4 compared multiple-patient monitoring of two vital signs with either spearcons, a visual display showing SpO2 and HR in the same temporal sequence as the spearcons, or a visual display showing multiple patient levels simultaneously. All displays conveyed which patients were abnormal with high accuracy. Visual displays better conveyed the vital sign levels for each patient, but cannot be used eyes-free. All displays showed accuracy decrements with working memory load. Spearcons may be viable for single and multiple patient monitoring. Further research should test spearcons with more vital signs, during multitasking, and longitudinally.

Spearcons for Patient Monitoring: Program of Laboratory-Based Feasibility Studies

“…When identifying the actual vital sign ranges for patients with abnormal vital signs, accuracy dropped as the number of patients with abnormal vital signs increased, but it was still greatly above chance. Similar results were found for the English spearcons by Sanderson et al (2019;Experiment 3). Note, however, that complete recall of all abnormal vital signs is a harsh test, and it is probably unrepresentative of how sequences of spearcons would be used in a clinical context.…”

“…We wondered whether the decrease in identification accuracy with the increased number of patients with abnormal vital signs increased was caused specifically by the load on auditory working memory, or whether it also would occur with a visual presentation of stimuli. When we ran the study with a visual (written) presentation of patient status, retaining the same timing as in the auditory presentation, we found a similar pattern of results as for the auditory presentation (Sanderson et al, 2019; Experiment 4). Identification accuracy was slightly higher with visual presentations, given that participants could simply read patient status from the visual display, but identification accuracy reduced to a similar degree as the number of patients with abnormal vital signs increased.…”

“…Participants using spearcons could identify both vital signs with 99% accuracy, but participants using earcons achieved only 60% (Li et al, 2017). We repeated the experiment with English spearcons, and found a similar result: 96% identification accuracy for spearcons but only 65% for earcons (Sanderson et al, 2019; Experiment 1). The above results are encouraging, but they open many further questions about whether spearcons are a viable format for conveying patient information.…”

“…In a first experiment with the English pulse oximetry spearcons (Sanderson et al, 2019; Experiment 2) we divided participants into three groups: a high information group who were told the actual words used in the spearcons, but received no training; a medium information group who were told that the spearcons represented information intended to help clinicians monitor the wellbeing of patients in a hospital; and a low information group who were told only that the spearcons were compressed speech. The high information group averaged 84% correct spearcon identification, but the medium and low information groups only 2% and 3% respectively.…”

The Impact of Concurrent Linguistic Tasks on Participants’ Identification of Spearcons

“…Auditory medical alarms in hospitals can be uninformative, nonactionable and false, which can lead clinicians to experience alarm fatigue that compromises patient safety. A potential solution is to replace alarms with spearcons that update clinicians about patient status intermittently using directly interpretable language, so letting clinicians determine when or if attention or clinical intervention is required (Sanderson et al, 2019). However, clinicians often multitask while monitoring patients, and they often perform concurrent tasks that require language (i.e., linguistic) skills.…”