Time and Number of Displays Impact Critical Signal Detection in Fetal Heart Rate Tracings

Abstract

Interest in centralized monitoring in labor and delivery units is growing because it affords the opportunity to monitor multiple patients simultaneously. However, a long history of research on sustained attention reveals these types of monitoring tasks can be problematic. The goal of the present experiment was to examine the ability of individuals to detect critical signals in fetal heart rate (FHR) tracings in one or more displays over an extended period of time. Seventy-two participants monitored one, two, or four computer-simulated FHR tracings on a computer display for the appearance of late decelerations over a 48-minute vigil. Measures of subjective stress and workload were also obtained before and after the vigil. The results showed that detection accuracy decreased over time and also declined as the number of displays increased. The subjective reports indicated that participants found the task to be stressful and mentally demanding, effortful, and frustrating. The results suggest that centralized monitoring that allows many patients to be monitored simultaneously may impose a detrimental attentional burden on the observer. Furthermore, this seemingly benign task may impose an additional source of stress and mental workload above what is commonly found in labor and delivery units.

The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate

“…Centralized multiple monitoring has been reported to be less accurate for detecting critical FHR monitoring signals due to the increased number of displays [16]. As the number of FHR tracings displayed on the screens increased with the addition of the patients from the primary hospitals, the impact of this increase on the interpretation accuracy should be quantitatively studied.…”

Birth Outcomes, Intervention Frequency, and the Disappearing Midwife—Potential Hazards of Central Fetal Monitoring: A Single Center Review

“…It is unknown whether CFM is a cost‐effective intervention. The substantial initial cost may possibly be offset by minimizing adverse events or by needing fewer staff to oversee the monitoring of many patients (although the ability to identify abnormal patterns can be compromised if allocated staff are too few or the screens suboptimal) . Alternatively CFM may lead to more intervention without improved outcomes as a result of inappropriate over‐surveillance.…”