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1.
Telemed J E Health ; 30(5): 1470-1478, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38215270

RESUMO

Background: Augmented reality head-worn displays (HWDs) may enable efficient remote support in the prehospital environment due to their hand-free operability, their "see-what-I-see" features, and their ability to superimpose digital content over the environment. Methods: In this simulation-based randomized controlled study, a remote mentor used either a phone or HWD to instruct 23 physicians on how to insert a Multi-Lumen Access Catheter into a mannequin. In the phone condition, information could be exchanged only verbally. In the HWD condition, the mentor could additionally see the participant's first-person view and show reference images. We hypothesized that participants who received instructions via the HWD would achieve better procedural performance (lower task completion times, fewer errors advancing the catheter) and exhibit different communication patterns than participants who received instructions via phone. Results: The HWD did not significantly reduce task completion times or errors during catheter advancement. However, by analyzing the frequency of communication events with a Poisson regression, we could demonstrate that with the HWD, the mentor had to request situation reports less often (p < 0.001) but provided more instructions (p = 0.004) and more feedback (p = 0.008). As a possible consequence, participants in the HWD condition rated their workload as lower than participants who used a phone to communicate (p = 0.45). Conclusion: The study demonstrates that HWD-based telemedicine systems can be rated positively by physicians, can benefit communication, and can provide more opportunities for the detection of clinical errors.


Assuntos
Realidade Aumentada , Tutoria , Análise e Desempenho de Tarefas , Humanos , Masculino , Feminino , Tutoria/métodos , Serviços Médicos de Emergência , Manequins , Adulto , Comunicação , Competência Clínica , Treinamento por Simulação/métodos
2.
J Med Syst ; 48(1): 62, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38888610

RESUMO

Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres-here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)-are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen's [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.


Assuntos
Ergonomia , Humanos , Eficiência Organizacional , Atenção à Saúde/organização & administração , Gestão de Riscos/organização & administração , Fluxo de Trabalho
3.
Pediatr Res ; 91(5): 1222-1230, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34183769

RESUMO

BACKGROUND: Many physiological aspects of the neonatal transition after birth are unobservable because relevant sensors do not yet exist, compromising clinicians' understanding of a neonate's physiological status. Given that a neonate's true physiological state is currently unavailable, we explored the feasibility of using clinicians' degree of concordance as an approximation of the true physiological state. METHODS: Two phases of structured interviews were conducted. In Phase 1 (N = 8) and Phase 2 (N = 12), we presented neonatal experts with eight graphical trajectories of real newborns' heart rate and oxygen saturation values in the first 10-15 min after birth. We elicited the participants' interpretations of potential underlying physiological conditions that could explain the vital sign patterns. RESULTS: The global differential diagnosis data for each phase produced the same pattern of results: (1) four trajectories produced a substantial degree of concordance among clinicians (61-80%) and (2) four trajectories produced a strong degree of concordance among clinicians (81-100%). CONCLUSIONS: It is possible to achieve a strong degree of concordance among neonatal experts' interpretations of newborn trajectories. Thus, using the degree of concordance as an approximation of the neonate's true physiological state in resuscitation after birth may be a promising direction to explore for cognitive aid design. IMPACT: Differential diagnoses with a good degree of concordance among expert neonatal clinicians could potentially substitute in part for the direct measurement of key physiological and anatomical variables of the neonatal transition, which is currently unavailable. The concordance of clinicians' judgements or inferences with regards to the true physiological state of the newborn during resuscitation after birth has never been explored. The findings provide a crucial first step toward using consensus of neonatal experts' judgements in the design of a cognitive aid to support clinicians' management of the newborns who require resuscitation after birth.


Assuntos
Parto , Ressuscitação , Feminino , Humanos , Recém-Nascido , Gravidez
4.
Hum Factors ; : 187208221116949, 2022 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-35934986

RESUMO

OBJECTIVE: A study of auditory displays for simulated patient monitoring compared the effectiveness of two sound categories (alarm sounds indicating general risk categories from international alarm standard IEC 60601-1-8 versus event-specific sounds according to the type of nursing unit) and two configurations (single-patient alarms versus multi-patient sequences). BACKGROUND: Fieldwork in speciality-focused high dependency units (HDU) indicated that auditory alarms are ambiguous and do not identify which patient has a problem. We tested whether participants perform better using auditory displays that identify the relevant patient and problem. METHOD: During simulated patient monitoring of four patients in a respiratory HDU, 60 non-clinicians heard either (a) IEC risk categories as single-patient alarm sounds, (b) event-specific categories as single-patient alarm sounds, (c) IEC risk categories in multi-patient sequences or (d) event-specific categories in multi-patient sequences. Participants performed a perceptual-motor task while monitoring patients; after detecting abnormal events, they identified the patient and the event. RESULTS: Participants hearing multi-patient sequences made fewer wrong patient identifications than participants hearing single-patient alarms. Advantages of event-specific categories emerged when IEC risk category sounds indicated more than one potential event. Even when IEC and event-specific sounds indicated the same unique event, spearcons supported better event identification than did auditory icon sounds. CONCLUSION: Auditory displays that unambiguously convey which patient is having what problem dramatically improve monitoring performance in a preclinical HDU simulation. APPLICATION: Time-compressed speech assists development of detailed risk categories needed in specific HDU contexts, and multi-patient sound sequences allow multiple patient wellbeing to be monitored.

5.
Hum Factors ; : 187208221118472, 2022 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-35993422

RESUMO

OBJECTIVE: Auditory enhancements to the pulse oximetry tone may help clinicians detect deviations from target ranges for oxygen saturation (SpO2) and heart rate (HR). BACKGROUND: Clinical guidelines recommend target ranges for SpO2 and HR during neonatal resuscitation in the first 10 minutes after birth. The pulse oximeter currently maps HR to tone rate, and SpO2 to tone pitch. However, deviations from target ranges for SpO2 and HR are not easy to detect. METHOD: Forty-one participants were presented with 30-second simulated scenarios of an infant's SpO2 and HR levels in the first minutes after birth. Tremolo marked distinct HR ranges and formants marked distinct SpO2 ranges. Participants were randomly allocated to conditions: (a) No Enhancement control, (b) Enhanced HR Only, (c) Enhanced SpO2 Only, and (d) Enhanced Both. RESULTS: Participants in the Enhanced HR Only and Enhanced SpO2 Only conditions identified HR and SpO2 ranges, respectively, more accurately than participants in the No Enhancement condition, ps < 0.001. In the Enhanced Both condition, the tremolo enhancement of HR did not affect participants' ability to identify SpO2 range, but the formants enhancement of SpO2 may have attenuated participants' ability to identify tremolo-enhanced HR range. CONCLUSION: Tremolo and formant enhancements improve range identification for HR and SpO2, respectively, and could improve clinicians' ability to identify SpO2 and HR ranges in the first minutes after birth. APPLICATION: Enhancements to the pulse oximeter tone to indicate clinically important ranges could improve the management of oxygen delivery to the neonate during resuscitation in the first 10 minutes after birth.

6.
Hum Factors ; : 187208221075851, 2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35466744

RESUMO

OBJECTIVE: In two experiments, we examined how quickly different visual alerts on a head-worn display (HWD) would capture participants' attention to a matrix of patient vital sign values, while multitasking. BACKGROUND: An HWD could help clinicians monitor multiple patients, regardless of where the clinician is located. We sought effective ways for HWDs to alert multitasking wearers to important events. METHODS: In two preclinical experiments, university student participants performed a visuomotor tracking task while simultaneously monitoring simulated patient vital signs on an HWD to detect abnormal values. Methods to attract attention to abnormal values included highlighting abnormal vital signs and imposing a white flash over the entire display. RESULTS: Experiment 1 found that participants detected abnormal values faster with high contrast than low contrast greyscale highlights, even while performing difficult tracking. In Experiment 2, a white flash of the entire screen quickly and reliably captured attention to vital signs, but less so on an HWD than on a conventional screen. CONCLUSION: Visual alerts on HWDs can direct users' attention to patient transition events (PTEs) even under high visual-perceptual load, but not as quickly as visual alerts on fixed displays. Aspects of the results have since been tested in a healthcare context. APPLICATION: Potential applications include informing the design of HWD interfaces for monitoring multiple processes and informing future research on capturing attention to HWDs.

7.
Ergonomics ; 65(2): 188-218, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34445922

RESUMO

Head-Worn Displays (HWD) can potentially support the mobile work of emergency responders, but it remains unclear whether teamwork is affected when emergency responders use HWDs. We reviewed studies that examined HWDs in emergency response contexts to evaluate the impact of HWDs on team performance and on team processes of situation awareness, communication, and coordination. Sixteen studies were identified through manual and systematic literature searches. HWDs appeared to improve the quality of team performance but they increased time to perform under some conditions; effects on team processes were mixed. We identify five challenges to explain the mixed results. We discuss four theoretical perspectives that might address the challenges and guide research needs-joint cognitive systems, distributed cognition, common ground, and dynamical systems. Researchers and designers should use process-based measures and apply greater theoretical guidance to uncover mechanisms by which HWDs shape team processes, and to understand the impact on team performance. Practitioner Summary: This review examines the effects of head-worn displays on teamwork performance and team processes for emergency response. Results are mixed, but study diversity challenges the search for underlying mechanisms. Guidance from perspectives such as joint cognitive systems, distributed cognition, common ground, and dynamical systems may advance knowledge in the area. Abbreviations: HWD: head-worn display; RC: remote collaboration; DD: data display; ARC: augmented remote collaboration; ACC: augmented collocated collaboration; SA: situation awareness; TSA: team situation awareness; CPR: cardiopulmonary resuscitation; SAGAT: situation awareness global assessment technique; SART: situation awareness rating technique.


Assuntos
Conscientização , Cognição , Comunicação , Apresentação de Dados , Humanos , Equipe de Assistência ao Paciente
8.
Biomed Instrum Technol ; 56(2): 46-57, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35671368

RESUMO

Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.


Assuntos
Oximetria , Oxigênio , Adulto , Humanos , Recém-Nascido
9.
Br J Anaesth ; 127(5): 677-680, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34481659

RESUMO

Modern computerised medical devices emit large numbers of tone-based alerts and alarms. Notifications that comprise auditory icons or natural human speech substantially increase the psychological salience of alerts and alarms and may allow a larger set of notifications to be used, as they do not require memorisation of arbitrary sounds.


Assuntos
Alarmes Clínicos , Humanos , Monitorização Fisiológica
10.
J Clin Monit Comput ; 35(4): 689-710, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32458169

RESUMO

OBJECTIVE: To gain a deeper understanding of the information requirements of clinicians conducting neonatal resuscitation in the first 10 min after birth. BACKGROUND: During the resuscitation of a newborn infant in the first minutes after birth, clinicians must monitor crucial physiological adjustments that are relatively unobservable, unpredictable, and highly variable. Clinicians' access to information regarding the physiological status of the infant is also crucial to determining which interventions are most appropriate. To design displays to support clinicians during newborn resuscitation, we must first carefully consider the information requirements. METHODS: We conducted a work domain analysis (WDA) for the neonatal transition in the first 10 min after birth. We split the work domain into two 'subdomains'; the physiology of the neonatal transition, and the clinical resources supporting the neonatal transition. A WDA can reveal information requirements that are not yet supported by resources. RESULTS: The physiological WDA acted as a conceptual tool to model the exact processes and functions that clinicians must monitor and potentially support during the neonatal transition. Importantly, the clinical resources WDA revealed several capabilities and limitations of the physical objects in the work domain-ultimately revealing which physiological functions currently have no existing sensor to provide clinicians with information regarding their status. CONCLUSION: We propose two potential approaches to improving the clinician's information environment: (1) developing new sensors for the information we lack, and (2) employing principles of ecological interface design to present currently available information to the clinician in a more effective way.


Assuntos
Ressuscitação , Humanos , Lactente , Recém-Nascido , Monitorização Fisiológica
11.
Br J Anaesth ; 125(5): 826-834, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32682554

RESUMO

BACKGROUND: We compared anaesthetists' ability to identify haemoglobin oxygen saturation (SpO2) levels using two auditory displays: one based on a standard pulse oximeter display (varying pitch plus alarm) and the other enhanced with additional sound properties (varying pitch plus tremolo and acoustic brightness) to differentiate SpO2 ranges. METHODS: In a counter-balanced crossover study in a simulator, 20 experienced anaesthetists supervised a junior colleague (an actor) managing two airway surgery scenarios: once while using the enhanced auditory display and once while using a standard auditory display. Participants were distracted with other tasks such as paperwork and workplace interruptions, but were required to identify when SpO2 transitioned between pre-set ranges (target, low, critical) and when other vital signs transitioned out of a target range. They also identified the range once a transition had occurred. Visual displays were available for all monitored vital signs, but the numerical value for SpO2 was excluded. RESULTS: Participants were more accurate and faster at detecting transitions to and from the target SpO2 range when using the enhanced display (100.0%, 3.3 s) than when using the standard display plus alarm (73.2%, 27.4 s) (P<0.001 and P=0.004, respectively). They were also more accurate at identifying the SpO2 range once a transition had occurred when using the enhanced display (100.0%) than when using the standard display plus alarm (57.1%; P<0.001). CONCLUSIONS: The enhanced auditory display helps anaesthetists judge SpO2 levels more effectively than current auditory displays and may facilitate 'eyes-free' monitoring.


Assuntos
Apresentação de Dados , Oximetria/instrumentação , Estimulação Acústica , Adulto , Anestesiologistas , Alarmes Clínicos , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas/organização & administração , Oxigênio/sangue , Inquéritos e Questionários , Sinais Vitais
12.
Hum Factors ; 62(1): 124-137, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31180734

RESUMO

BACKGROUND: The pulse oximeter (PO) provides anesthesiologists with continuous visual and auditory information about a patient's oxygen saturation (SpO2). However, anesthesiologists' attention is often diverted from visual displays, and clinicians may inaccurately judge SpO2 values when relying on conventional PO auditory tones. We tested whether participants could identify SpO2 value (e.g., "97%") better with acoustic enhancements that identified three discrete clinical ranges by either changing abruptly at two threshold values (stepped-effects) or changing incrementally with each percentage value of SpO2 (smooth-effects). METHOD: In all, 79 nonclinicians participated in a between-subjects experiment that compared performance of participants using the stepped-effects display with those who used the smooth-effects display. In both conditions, participants heard sequences of 72 tones whose pitch directly correlated to SpO2 value, and whose value could change incrementally. Primary outcome was percentage of responses that correctly identified the absolute SpO2 percentage, ±1, of the last pulse tone in each sequence. RESULTS: Participants using the stepped-effects auditory tones identified absolute SpO2 percentage more accurately (M = 53.7%) than participants using the smooth-effects tones (M = 47.9%, p = .038). Identification of range and detection of transitions between ranges showed even stronger advantages for the stepped-effects display (p < .005). CONCLUSION: The stepped-effects display has more pronounced auditory cues at SpO2 range transitions, from which participants can better infer absolute SpO2 values. Further development of a smooth-effects display for this purpose is not necessary.


Assuntos
Atenção/fisiologia , Percepção Auditiva , Alarmes Clínicos , Sinais (Psicologia) , Desenho de Equipamento , Monitorização Fisiológica , Oximetria , Consumo de Oxigênio , Desempenho Psicomotor/fisiologia , Adulto , Alarmes Clínicos/normas , Feminino , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Oximetria/instrumentação , Oximetria/normas , Adulto Jovem
13.
Anesth Analg ; 129(4): 997-1004, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31283622

RESUMO

BACKGROUND: When engaged in visually demanding tasks, anesthesiologists depend on the auditory display of the pulse oximeter (PO) to provide information about patients' oxygen saturation (SpO2). Current auditory displays are not always effective at providing SpO2 information. In this laboratory study, clinician and nonclinician participants identified SpO2 parameters using either a standard auditory display or an auditory display enhanced with additional acoustic properties while performing distractor tasks and in the presence of background noise. METHODS: In a counterbalanced crossover design, specialist or trainee anesthesiologists (n = 25) and nonclinician participants (n = 28) identified SpO2 parameters using standard and enhanced PO auditory displays. Participants performed 2 distractor tasks: (1) arithmetic verification and (2) keyword detection. Simulated background operating room noise played throughout the experiment. Primary outcomes were accuracies to (1) detect transitions to and from an SpO2 target range and (2) identify SpO2 range (target, low, or critical). Secondary outcomes included participants' latency to detect target transitions, accuracy to identify absolute SpO2 values, accuracy and latency of distractor tasks, and subjective judgments about tasks. RESULTS: Participants were more accurate at detecting target transitions using the enhanced display (87%) than the standard display (57%; odds ratio, 7.3 [95% confidence interval {CI}, 4.4-12.3]; P < .001). Participants were also more accurate at identifying SpO2 range using the enhanced display (86%) than the standard display (76%; odds ratio, 2.7 [95% CI, 1.6-4.6]; P < .001). Secondary outcome analyses indicated that there were no differences in performance between clinicians and nonclinicians for target transition detection accuracy and latency, SpO2 range identification accuracy, or absolute SpO2 value identification. CONCLUSIONS: The enhanced auditory display supports more accurate detection of target transitions and identification of SpO2 range for both clinicians and nonclinicians. Despite their previous experience using PO auditory displays, clinicians in this laboratory study were no more accurate in any SpO2 outcomes than nonclinician participants.


Assuntos
Acústica/instrumentação , Anestesiologistas/psicologia , Percepção Auditiva , Alarmes Clínicos , Oximetria/instrumentação , Oxigênio/sangue , Estimulação Acústica , Adulto , Atenção , Biomarcadores/sangue , Competência Clínica , Estudos Cross-Over , Feminino , Humanos , Masculino , Ruído/efeitos adversos , Mascaramento Perceptivo , Detecção de Sinal Psicológico , Fatores de Tempo
14.
J Clin Monit Comput ; 33(6): 1119-1127, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30721389

RESUMO

PURPOSE: Supervising anesthesiologists overseeing several operating rooms must be aware of the status of multiple patients, so they can consult with the anesthetist in single operating rooms or respond quickly to critical events. However, maintaining good situation awareness can be challenging when away from patient bedsides or a central monitoring station. In this proof-of-concept study, we evaluated the potential of a head-worn display that showed multiple patients' vital signs and alarms to improve supervising anesthesiologists' situation awareness. METHODS: Eight supervising anesthesiologists each monitored the vital signs of patients in six operating rooms for 3 h with the head-worn display, and for another 3 h without the head-worn display. In interviews with each anesthesiologist, we assessed in which situations the head-worn display was used and whether the continuous availability of the vital signs improved situation awareness. We also measured situation awareness quantitatively from six of the eight anesthesiologists, by instructing them to press a button whenever they noticed a patient alarm. RESULTS: The median number of patient alarms occurring was similar when the anesthesiologists monitored with the head-worn display (42.0) and without the head-worn display (40.5). However, the anesthesiologists noticed significantly more patient alarms with the head-worn display (66.7%) than without (7.1%), P = 0.028, and they reported improved situation awareness with the head-worn display. The head-worn display helped the anesthesiologists to perceive and comprehend patients' current status and to anticipate future developments. A negative effect of the head-worn display was its tendency to distract during demanding procedures. CONCLUSIONS: Head-worn displays can improve supervising anesthesiologists' situation awareness in multiple-patient monitoring situations. The anesthesiologists who participated in the study expressed enthusiasm about monitoring patients with a head-worn display and wished to use and evaluate it further.


Assuntos
Anestesiologistas , Anestesiologia/métodos , Conscientização , Monitorização Intraoperatória/instrumentação , Adulto , Estudos Cross-Over , Apresentação de Dados , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Monitorização Fisiológica/métodos , Salas Cirúrgicas , Médicos , Reprodutibilidade dos Testes , Interface Usuário-Computador , Sinais Vitais
15.
Hum Factors ; 61(7): 1025-1036, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31469315

RESUMO

OBJECTIVE: We address the problem of how researchers investigate the actual or potential causal connection between interruptions and medical errors, and whether interventions might reduce the potential for harm. BACKGROUND: It is widely assumed that interruptions lead to errors and patient harm. However, many reviewers and authors have commented that there is not strong evidence for a causal connection. METHOD: We introduce a framework of criteria for assessing how strongly evidence implies causality: the so-called Bradford Hill criteria. We then examine four key "metanarratives" of research into interruptions in health care-applied cognitive psychology, epidemiology, quality improvement, and cognitive systems engineering-and assess how each tradition has addressed the causal connection between interruptions and error. RESULTS: Outcomes of applying the Bradford Hill criteria are that the applied cognitive psychology and epidemiology metanarratives address the causal connection relatively directly, whereas the quality improvement metanarrative merely assumes causality, and the cognitive systems engineering metanarrative either implicitly or explicitly questions the feasibility of finding a direct causal connection with harm. CONCLUSION: The Bradford Hill criteria are useful for evaluating the existing literature on the relationship between interruptions in health care, clinical errors, and the potential for patient harm. In the future, more attention is needed to the issue of why interruptions usually do not lead to harm, and the implications for how we approach patient safety.


Assuntos
Atenção , Erros Médicos , Segurança do Paciente , Causalidade , Humanos , Psicologia Aplicada , Qualidade da Assistência à Saúde
16.
Hum Factors ; 61(1): 119-138, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30260681

RESUMO

OBJECTIVE: We tested whether enhanced sonifications would improve participants' ability to judge the oxygen saturation levels (SpO2) of simulated neonates in the first 10 min after birth. BACKGROUND: During the resuscitation of a newborn infant, clinicians must keep the neonate's SpO2 levels within the target range, however the boundaries for the target range change each minute during the first 10 min after birth. Resuscitation places significant demand on the clinician's visual attention, and the pulse oximeter's sonification could provide eyes-free monitoring. However, clinicians have difficulty judging SpO2 levels using the current sonification. METHOD: In two experiments, nonclinicians' ability to detect SpO2 range and direction-while performing continuous arithmetic problems-was tested with enhanced versus conventional sonifications. In Experiment 1, tremolo signaled when SpO2 had deviated below or above the target range. In Experiment 2, tremolo plus brightness signaled when SpO2 was above target range, and tremolo alone when SpO2 was below target range. RESULTS: The tremolo sonification improved range identification accuracy over the conventional display (81% vs. 63%, p < .001). The tremolo plus brightness sonification further improved range identification accuracy over the conventional display (92% vs. 62%, p <.001). In both experiments, there was no difference across conditions in arithmetic task accuracy ( p >.05). CONCLUSION: Using the enhanced sonifications, participants identified SpO2 range more accurately despite a continuous distractor task. APPLICATION: An enhanced pulse oximetry sonification could help clinicians multitask more effectively during neonatal resuscitations.


Assuntos
Monitorização Fisiológica/instrumentação , Oximetria/instrumentação , Ressuscitação/instrumentação , Desenho de Equipamento , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estudos Prospectivos , Som , Interface Usuário-Computador
17.
Hum Factors ; 61(2): 288-304, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30260675

RESUMO

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.


Assuntos
Alarmes Clínicos , Apresentação de Dados , Desenho de Equipamento , Monitorização Fisiológica/instrumentação , Som , Fala , Sinais Vitais , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
18.
Hum Factors ; 61(4): 537-563, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30608190

RESUMO

OBJECTIVE: To investigate whether head-worn displays (HWDs) help mobile participants make better alarm management decisions and achieve better situation awareness than alarms alone. BACKGROUND: Patient alarms occur frequently in hospitals but often do not require clinical intervention. Clinicians may become desensitized to alarms and fail to respond to clinically relevant alarms. HWDs could make patient information continuously accessible, support situation awareness, and help clinicians prioritize alarms. METHOD: Experiment 1 ( n = 76) tested whether nonclinicians monitoring simulated patients benefited from vital sign information continuously displayed on an HWD while they performed a secondary calculation task. Experiment 2 ( n = 13) tested, across three separate experimental sessions, how effectively nursing trainees monitored simulated patients' vital signs under three different display conditions while they assessed a simulated patient. RESULTS: In Experiment 1, participants who had access to continuous patient information on an HWD responded to clinically important alarms 25.9% faster and were 6.7 times less likely to miss alarms compared to participants who only heard alarms. In Experiment 2, participants using an HWD answered situation awareness questions 18.9% more accurately overall than when they used alarms only. However, the effect was significant in only two of the three experimental sessions. CONCLUSION: HWDs may help users maintain continuous awareness of multiple remote processes without affecting their performance on ongoing tasks. APPLICATION: The outcomes may apply to contexts where access to continuous streams of information from remote locations is useful, such as patient monitoring or clinical supervision.


Assuntos
Conscientização , Alarmes Clínicos , Monitorização Fisiológica , Segurança do Paciente , Dispositivos Eletrônicos Vestíveis , Tomada de Decisões , Humanos , Recursos Humanos de Enfermagem Hospitalar , Treinamento por Simulação
19.
Eur J Cancer Care (Engl) ; 27(5): e12869, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29956859

RESUMO

To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR] = 1.18, 95%CI = 1.12-1.25) and higher distress (OR = 1.68, 95%CI = 1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR = 1.12, 95%CI = 1.06-1.19) and lower distress (OR = 0.58, 95%CI = 0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.


Assuntos
Neoplasias , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Apoio Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Avaliação das Necessidades/organização & administração , Neoplasias/complicações , Neoplasias/psicologia , Neoplasias/terapia , Serviço Hospitalar de Oncologia/organização & administração , Cuidados Paliativos/estatística & dados numéricos , Psicoterapia , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia , Triagem/organização & administração , Adulto Jovem
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