Abstract
BackgroundMaintaining 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.MethodsA 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.ResultsIn 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 avatar-based 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.ConclusionsIn 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.
Highlights
Maintaining adequate situation awareness is crucial for patient safety
We evaluate the usefulness of Visual Patient technology for monitoring multiple patients at the same time, as it is practiced in the modern operating room and intensive care station central station monitors
Using avatar-based monitoring, anesthesia providers perceived a median of 11 (IQR 8 to 15) vital signs, compared to only 7 (IQR 4 to 9), using conventional monitoring, p < 0.001, mean of differences 4 vital signs, 95% confidence interval (CI) 2 to 6, effect size d = 0.67
Summary
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. 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. The World Health Organization, in its guidelines for safe surgery, considers the continuous presence of a professionally trained and vigilant anesthesia provider using standardized patient monitoring to be of central importance for safe perioperative care. In the operating room and the intensive care unit, maintaining situation awareness goes beyond just patient monitoring. It is a constantly evolving multi-directional process that takes place between care providers and their environment, which may include, e.g., the patient, other team members, external and self-induced distractions. Actions and events like these, may change the care providers’ mental model and influence their further actions [5]
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