Abstract
BackgroundPatient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring.ObjectiveWe aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring.MethodsIn this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies.ResultsParticipants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=−3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=−1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001).ConclusionsThis eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.
Highlights
The World Health Organization considers continuous patient monitoring to be "extremely important"for the safety of the more than 313 million patients worldwide undergoing surgery each year.[1, 2] In operating rooms and intensive care units around the world, monitors help millions of health care providers every day to make critical treatment decisions.[3, 4] previous research has found that conventional patient monitoring based on numbers and waveforms is not ideally suited for transferring patient status information to health care providers
Participants visually fixated more vital signs per scenario, median (IQR): 10 (9-11) vs. 6 (4-8), p
I.e., pulse rate, blood pressure, oxygen saturation, and respiratory rate were visible almost the entire time of a scenario with avatar-based monitoring, while with conventional monitoring, these were only visible for fractions of the observations
Summary
The World Health Organization considers continuous patient monitoring to be "extremely important"for the safety of the more than 313 million patients worldwide undergoing surgery each year.[1, 2] In operating rooms and intensive care units around the world, monitors help millions of health care providers every day to make critical treatment decisions.[3, 4] previous research has found that conventional patient monitoring based on numbers and waveforms is not ideally suited for transferring patient status information to health care providers. The design of the avatar technology, which presents the information about multiple vital signs integrated into forms and colors of the corresponding anatomical parts of a patient model enabled parallel perception of multiple vital signs, and thereby increased the number of visually fixated vital signs and the time available to fixate each vital sign With this finding confirmed by eye-tracking, this study adds a new and higher level of empirical evidence as to why avatar-based monitoring improves the perception of vital sign information compared to conventional monitoring. While current state-of-the-art patient monitors display vital signs in the form of numbers and curve forms, Visual Patient technology creates an easy to interpret virtual patient avatar model, which, in a previous study, enabled anesthesia providers to perceive more vital sign information during short glances than conventional monitoring. We used eye-tracking technology to study the deeper mechanisms underlying information perception in both, conventional and avatarbased patient monitoring
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