Attention capture by own name decreases with speech compression.

Auditory stimuli that are relevant to a listener have the potential to capture focal attention even when unattended, the listener's own name being a particularly effective stimulus. We report two experiments to test the attention-capturing potential of the listener's own name in normal speech and time-compressed speech. In Experiment 1, 39 participants were tested with a visual word categorization task with uncompressed spoken names as background auditory distractors. Participants' word categorization performance was slower when hearing their own name rather than other names, and in a final test, they were faster at detecting their own name than other names. Experiment 2 used the same task paradigm, but the auditory distractors were time-compressed names. Three compression levels were tested with 25 participants in each condition. Participants' word categorization performance was again slower when hearing their own name than when hearing other names; the slowing was strongest with slight compression and weakest with intense compression. Personally relevant time-compressed speech has the potential to capture attention, but the degree of capture depends on the level of compression. Attention capture by time-compressed speech has practical significance and provides partial evidence for the duplex-mechanism account of auditory distraction.

Effects of multitasking on interpreting a spearcon sequence display for monitoring multiple patients.

Spearcons are time-compressed speech phrases. When arranged in a sequence representing vital signs of multiple patients, spearcons may be more informative than conventional auditory alarms. However, multiple resource theory suggests that certain timeshared tasks might interfere with listeners' ability to understand spearcons. We tested the relative interference with spearcon identification from the following ongoing tasks: (1) manual tracking, (2) linguistic detection of spoken target words, (3) arithmetic true-false judgments, or (4) an ignored background speech control. Participants were 80 non-clinicians. The linguistic task worsened spearcon identification more than the tracking task, p < .001, and more than ignored background speech, p = .012. The arithmetic task worsened spearcon identification more than the tracking task, p < .001. The linguistic task and arithmetic task both worsened performance, p = .674. However, no ongoing task affected participants' ability to detect which patient(s) in a sequence had abnormal vital signs. Future research could investigate whether timeshared tasks affect non-speech auditory alerts.

Comparison of the Effects of Automated and Manual Record Keeping on Anesthetists' Monitoring Performance: Randomized Controlled Simulation Study.

BACKGROUND: Anesthesia information management systems (AIMSs) automatically import real-time vital signs from physiological monitors to anesthetic records, replacing part of anesthetists' traditional manual record keeping. However, only a handful of studies have examined the effects of AIMSs on anesthetists' monitoring performance. OBJECTIVE: This study aimed to compare the effects of AIMS use and manual record keeping on anesthetists' monitoring performance, using a full-scale high-fidelity simulation. METHODS: This simulation study was a randomized controlled trial with a parallel group design that compared the effects of two record-keeping methods (AIMS vs manual) on anesthetists' monitoring performance. Twenty anesthetists at a tertiary hospital in Hong Kong were randomly assigned to either the AIMS or manual condition, and they participated in a 45-minute scenario in a high-fidelity simulation environment. Participants took over a case involving general anesthesia for below-knee amputation surgery and performed record keeping. The three primary outcomes were participants' (1) vigilance detection accuracy (%), (2) situation awareness accuracy (%), and (3) subjective mental workload (0-100). RESULTS: With regard to the primary outcomes, there was no significant difference in participants' vigilance detection accuracy (AIMS, 56.7% vs manual, 56.7%; P=.50), and subjective mental workload was significantly lower in the AIMS condition than in the manual condition (AIMS, 34.2 vs manual, 46.7; P=.02). However, the result for situation awareness accuracy was inconclusive as the study did not have enough power to detect a difference between the two conditions. CONCLUSIONS: Our findings suggest that it is promising for AIMS use to become a mainstay of anesthesia record keeping. AIMSs are effective in reducing anesthetists' workload and improving the quality of their anesthetic record keeping, without compromising vigilance.

Human Error: The Impact of Job Insecurity on Attention-Related Cognitive Errors and Error Detection.

(1) Background: Work-related stress is a major contributor to human error. One significant workplace stressor is job insecurity, which has been linked to an increased likelihood of experiencing burnout. This, in turn, might affect human error, specifically attention-related cognitive errors (ARCES) and the ability to detect errors. ARCES can be costly for organizations and pose a safety risk. Equally detrimental effects can be caused by failure to detect errors before they can cause harm. (2) Methods: We gathered self-report and behavioral data from 148 employees working in educational, financial and medical sectors in China. We designed and piloted an error detection task in which employees had to compare fictitious customer orders to deliveries of an online shop. We tested for indirect effects using the PROCESS macro with bootstrapping (3) Results: Our findings confirmed indirect effects of job insecurity on both ARCES and the ability to detect errors via burnout. (4) Conclusions: The present research shows that job insecurity influences making and detecting errors through its relationship with burnout. These findings suggest that job insecurity could increase the likelihood for human error with potential implications for employees' safety and the safety of others.

Visual differentiation and recognition memory of look-alike drug names: effects of disfluent format, text enhancement and exposure time.

Three computer-based experiments were conducted to examine whether disfluent format, enhanced text, and increased exposure time improve the accuracy of visual differentiation and recognition memory of look-alike drug names. A three-way, repeated-measures look-alike drug name differentiation test assessed the visual differentiation accuracy of 30 nursing students (Experiment 1) and 15 nurses (Experiment 2). A two-way, repeated-measures recognition memory test examined the recognition memory accuracy of 15 nurses for look-alike drug names (Experiment 3). We found that making drug names disfluent did not significantly improve differentiation (Experiment 2) or memory accuracy (Experiment 3), but even impaired differentiation accuracy (Experiment 1). Enhanced text and longer exposure time significantly improved differentiation accuracy (Experiments 1 and 2). However, the enhanced text did not improve recognition memory (Experiment 3). We suggest that making look-alike drug names disfluent is not favourable. Enhanced text and longer exposure times are effective in supporting visual differentiation of look-alike drug names. Practitioner Summary: Confusion arising from look-alike drug names may compromise patient safety. Three experiments examined the effects of disfluent format, text enhancement and increased exposure time on visual and memory performances. Making drug names more difficult to read did not improve performance. Enhancing text design and increasing exposure (i.e. reading) time improved visual differentiation between medications, but did not improve the recognition of medications from memory. Abbreviations: SEEV: Salience-effort-expectancy-value; FDA: Food and Drug Administration; ANOVA: analysis of variance; SD: standard deviation, DF: disfluent format; TE: text enhancement; ET: exposure time.

Monitoring vital signs with time-compressed speech.

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. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Spearcon Sequences for Monitoring Multiple Patients: Laboratory Investigation Comparing Two Auditory Display Designs.

OBJECTIVE: The aim was to compare the effectiveness of two auditory displays, implemented with spearcons (time-compressed speech), for monitoring multiple patients. BACKGROUND: Sequences of sounds can convey information about patients' vital signs, such as oxygen saturation (SpO2) and heart rate (HR). We tested whether participants could monitor five patients using spearcon-based sound sequences. METHOD: A 2 × 3 within-subjects design was used. The first factor was interface, with two levels: the ALL interface used spearcons to convey vital signs for all five patients, whereas the ABN (abnormal) interface represented patients who had normal vital signs with a low-pitched single-tone sound and patients who had at least one abnormal vital sign with spearcons. The second factor was the number of patients who had at least one abnormal vital sign: there were one, two, or three such patients in each monitoring sequence. Participants were 40 nonclinicians. RESULTS: Participants identified abnormal patients' SpO2 and HR levels and located abnormal patients in the sound sequence more accurately with the ABN interface than the ALL interface. Accuracy declined as the number of abnormal patients increased. Participants associated ABN with easier identification of vital signs, resulting in higher ratings of confidence and pleasantness compared with ALL. CONCLUSION: Sequences of spearcons may support effective eyes-free monitoring of multiple patients. APPLICATION: Sequences of spearcons may be useful in monitoring multiple patients and the underlying design principles may extend to monitoring in other domains such as industrial process control or control of multiple autonomous vehicles.

Effects of monetary reward and punishment on information checking behaviour: An eye-tracking study.

The aim of the present study was to investigate the effect of error consequence, as reward or punishment, on individuals' checking behaviour following data entry. This study comprised two eye-tracking experiments that replicate and extend the investigation of Li et al. (2016) into the effect of monetary reward and punishment on data-entry performance. The first experiment adopted the same experimental setup as Li et al. (2016) but additionally used an eye tracker. The experiment validated Li et al. (2016) finding that, when compared to no error consequence, both reward and punishment led to improved data-entry performance in terms of reducing errors, and that no performance difference was found between reward and punishment. The second experiment extended the earlier study by associating error consequence to each individual trial by providing immediate performance feedback to participants. It was found that gradual increment (i.e. reward feedback) also led to significantly more accurate performance than no error consequence. It is unclear whether gradual increment is more effective than gradual decrement because of the small sample size tested. However, this study reasserts the effectiveness of reward on data-entry performance.

Theoretical approaches of online social network interventions and implications for behavioral change: a systematic review.

RATIONAL, AIMS AND OBJECTIVES: The aim of this review was to identify general theoretical frameworks used in online social network interventions for behavioral change. To address this research question, a PRISMA-compliant systematic review was conducted. METHODS: A systematic review (PROSPERO registration number CRD42014007555) was conducted using 3 electronic databases (PsycINFO, Pubmed, and Embase). Four reviewers screened 1788 abstracts. RESULTS: 15 studies were selected according to the eligibility criteria. Randomized controlled trials and controlled studies were assessed using Cochrane Collaboration's "risk-of-bias" tool, and narrative synthesis. Five eligible articles used the social cognitive theory as a framework to develop interventions targeting behavioral change. Other theoretical frameworks were related to the dynamics of social networks, intention models, and community engagement theories. Only one of the studies selected in the review mentioned a well-known theory from the field of health psychology. CONCLUSION: Conclusions were that guidelines are lacking in the design of online social network interventions for behavioral change. Existing theories and models from health psychology that are traditionally used for in situ behavioral change should be considered when designing online social network interventions in a health care setting.

Spearcons for Patient Monitoring: Laboratory Investigation Comparing Earcons and Spearcons.

Objective We compared the effectiveness of single-tone earcons versus spearcons in conveying information about two commonly monitored vital signs: oxygen saturation and heart rate. Background The uninformative nature of many medical alarms-and clinicians' lack of response to alarms-is a widespread problem that can compromise patient safety. Auditory displays, such as earcons and spearcons (speech-based earcons), may help clinicians maintain awareness of patients' well-being and reduce their reliance on alarms. Earcons are short abstract sounds whose properties represent different types and levels of information, whereas spearcons are time-compressed spoken phrases that directly state their meaning. Listeners might identify patient vital signs more accurately with spearcons than with earcons. Method In Experiment 1 we compared how accurately 40 nonclinician participants using either (a) single-tone earcons differentiated by timbre and tremolo or (b) Cantonese spearcons recorded using a female Cantonese voice could identify both oxygen saturation and heart rate levels. In Experiment 2 we tested the identification performance of six further nonclinician participants with spearcons recorded using a male Cantonese voice. Results In Experiment 1, participants using spearcons identified both vital signs together more accurately than did participants using earcons. Participants using Cantonese spearcons also learned faster, completed trials faster, identified individual vital signs more accurately, and felt greater ease and more confident when identifying oxygen saturation levels. Experiment 2 verified the previous findings with male-voice Cantonese spearcons. Conclusion Participants identified vital signs more accurately using spearcons than with the single-tone earcons. Application Spearcons may be useful for patient monitoring in situations in which intermittently presented information is desirable.

Effects of monetary reward and punishment on information checking behaviour.

Two experiments were conducted to examine whether checking one's own work can be motivated by monetary reward and punishment. Participants were randomly assigned to one of three conditions: a flat-rate payment for completing the task (Control); payment increased for error-free performance (Reward); payment decreased for error performance (Punishment). Experiment 1 (N = 90) was conducted with liberal arts students, using a general data-entry task. Experiment 2 (N = 90) replicated Experiment 1 with clinical students and a safety-critical 'cover story' for the task. In both studies, Reward and Punishment resulted in significantly fewer errors, more frequent and longer checking, than Control. No such differences were obtained between the Reward and Punishment conditions. It is concluded that error consequences in terms of monetary reward and punishment can result in more accurate task performance and more rigorous checking behaviour than errors without consequences. However, whether punishment is more effective than reward, or vice versa, remains inconclusive.

A systematic review of the psychological literature on interruption and its patient safety implications.

OBJECTIVE: To understand the complex effects of interruption in healthcare. MATERIALS AND METHODS: As interruptions have been well studied in other domains, the authors undertook a systematic review of experimental studies in psychology and human-computer interaction to identify the task types and variables influencing interruption effects. RESULTS: 63 studies were identified from 812 articles retrieved by systematic searches. On the basis of interruption profiles for generic tasks, it was found that clinical tasks can be distinguished into three broad types: procedural, problem-solving, and decision-making. Twelve experimental variables that influence interruption effects were identified. Of these, six are the most important, based on the number of studies and because of their centrality to interruption effects, including working memory load, interruption position, similarity, modality, handling strategies, and practice effect. The variables are explained by three main theoretical frameworks: the activation-based goal memory model, prospective memory, and multiple resource theory. DISCUSSION: This review provides a useful starting point for a more comprehensive examination of interruptions potentially leading to an improved understanding about the impact of this phenomenon on patient safety and task efficiency. The authors provide some recommendations to counter interruption effects. CONCLUSION: The effects of interruption are the outcome of a complex set of variables and should not be considered as uniformly predictable or bad. The task types, variables, and theories should help us better to identify which clinical tasks and contexts are most susceptible and assist in the design of information systems and processes that are resilient to interruption.

Why is it so difficult to measure the effects of interruptions in healthcare?

Interruptions are a complex phenomenon where multiple variables including the characteristics of primary tasks, the interruptions themselves, and the environment may influence patient safety and workflow outcomes. Observational studies present significant challenges for recording many of the process variables that influence the effects of interruptions. Controlled experiments provide an opportunity to examine the specific effects of variables on errors and efficiency. Computational models can be used to identify the situations in which interruptions to clinical tasks could be disruptive and to investigate the aggregate effects of interruptions.

Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects.

OBJECTIVE: To examine the effect of interruptions and task complexity on error rates when prescribing with computerized provider order entry (CPOE) systems, and to categorize the types of prescribing errors. DESIGN: Two within-subject factors: task complexity (complex vs simple) and interruption (interruption vs no interruption). Thirty-two hospital doctors used a CPOE system in a computer laboratory to complete four prescribing tasks, half of which were interrupted using a counterbalanced design. MEASUREMENTS: Types of prescribing errors, error rate, resumption lag, and task completion time. RESULTS: Errors in creating and updating electronic medication charts that were measured included failure to enter allergy information; selection of incorrect medication, dose, route, formulation, or frequency of administration from lists and drop-down menus presented by the CPOE system; incorrect entry or omission in entering administration times, start date, and free-text qualifiers; and omissions in prescribing and ceasing medications. When errors occurred, the error rates across the four prescribing tasks ranged from 0.5% (1 incorrect medication selected out of 192 chances for selecting a medication or error opportunities) to 16% (5 failures to enter allergy information out of 32 error opportunities). Any impact of interruptions on prescribing error rates and task completion times was not detected in our experiment. However, complex tasks took significantly longer to complete (F(1, 27)=137.9; p<0.001) and when execution was interrupted they required almost three times longer to resume compared to simple tasks (resumption lag complex=9.6 seconds, SD=5.6; resumption lag simple=3.4 seconds, SD=1.7; t(28)=6.186; p<0.001). CONCLUSION: Most electronic prescribing errors found in this study could be described as slips in using the CPOE system to create and update electronic medication charts. Cues available within the user interface may have aided resumption of interrupted tasks making CPOE systems robust to some interruption effects. Further experiments are required to rule out any effect interruption might have on CPOE error rates.

Personal experience in doctor and patient decision making: from psychology to medicine.

Traditional decision research shows that when people are told the probability of a rare event (e.g. the chance of side effects), they generally treat this event as if it were more likely than its objective probability (overweighting). In contrast, recent studies indicate that when outcomes are experienced firsthand, people tend to underweight the probability of rare events. In this paper, we suggest that the distinction between described and experienced information can play a significant role in shared decision making, and can provide a plausible explanation for some discrepancies between the perspectives of doctors and patients. We highlight some of the advantages and disadvantages of experiential and description-based information, and how knowledge of these might be used to improve risk communication.

The effect of interruptions on postcompletion and other procedural errors: an account based on the activation-based goal memory model.

A postcompletion error (PCE) is a specific kind of cognitive slip that involves omitting a final task step after the main goal of the task is accomplished. It is notoriously difficult to provoke (and hence study) slips under experimental conditions. In this paper, the authors present an experimental task paradigm that has been shown to be effective for studying PCEs in routine procedural tasks. Two studies were carried out to examine the effect of interruption position and task structure on the prevalence of PCEs. It was found that significantly more PCEs were obtained when an interruption occurred just before the PC step than when an interruption occurred at any other position in the task. The authors account for this effect in terms of Altmann and Trafton's activation-based goal memory model. The same interruption effect was obtained for some, but not all, other procedural errors; the authors discuss the nature of these errors and likely explanations for the differences.