The Influence of Audible Alarm Loudness and Type on Clinical Multitasking.

In high-consequence industries such as health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts providers attending to multiple concurrent tasks. Alarms levels are unnecessarily high and alarm signals are uninformative. In a laboratory-based task setting, we studied 25 anesthesiology residents' responses to auditory alarms in a multitasking paradigm comprised of three tasks: patient monitoring, speech perception/intelligibility, and visual vigilance. These tasks were in the presence of background noise plus/minus music, which served as an attention-diverting stimulus. Alarms signified clinical decompensation and were either conventional alarms or a novel informative auditory icon alarm. Both alarms were presented at four different levels. Task performance (accuracy and response times) were analyzed using logistic and linear mixed-effects regression. Salient findings were 1), the icon alarm had similar performance to the conventional alarm at a +2 dB signal-to-noise-ratio (SNR) (accuracy: OR 1.21 (95% CI 0.88, 1.67), response time: 0.04 s at 2 dB (95% CI: -0.16, 0.24), which is a much lower level than current clinical environments; 2) the icon alarm was associated with 27% greater odds (95% CI: 18%, 37%) of correctly addressing the vigilance task, regardless of alarm SNR, suggesting crossmodal/multisensory multitasking benefits; and 3) compared to the conventional alarm, the icon alarm was associated with an absolute improvement in speech perception of 4% in the presence of an attention-diverting auditory stimulus (p = 0.031). These findings suggest that auditory icons can provide multitasking benefits in cognitively demanding clinical environments.

Improving Training Motivation and Transfer in Hospitals: Extension of a Conceptual Model.

Health-care professionals undergo numerous training programs each year in order to fulfill licensure requirements and organizational obligations. However, evidence suggests that a substantial amount of what is taught during training is never learned or transferred back to routine work. A major contributor to this issue is low training motivation. Prior conceptual models on training transfer in the organizational sciences literature consider this deficit, yet do not account for the unique conditions of the hospital setting. This chapter seeks to close this gap by adapting conceptual models of training transfer to this setting that are grounded in organizational science. Based on theory and supplemented by semistructured key informant interviews (i.e., organizational leaders and program directors), we introduce an applied model of training motivation to facilitate training transfer in the hospital setting. In this model, training needs analysis is positioned as a key antecedent to ensure support for training, relevant content, and perceived utility of training. We posit that these factors, along with training design and logistics, enhance training motivation in hospital environments. Further, we suggest that training motivation subsequently impacts learning and transfer, with elements of the work environment also serving as moderators of the learning-transfer relationship. Factors such as external support for training content (e.g., from accrediting bodies) and allocation of time for training are emphasized as facilitators. The proposed model suggests there are factors unique to the hospital work setting that impact training motivation and transfer that should be considered when developing and implementing training initiatives in this setting.

Enhanced auditory spatial performance using individualized head-related transfer functions: An event-related potential study.

This study examined event-related potential (ERP) correlates of auditory spatial benefits gained from rendering sounds with individualized head-related transfer functions (HRTFs). Noise bursts with identical virtual elevations (0°-90°) were presented back-to-back in 5-10 burst "runs" in a roving oddball paradigm. Detection of a run's start (i.e., elevation change detection) was enhanced when bursts were rendered with an individualized compared to a non-individualized HRTF. ERPs showed increased P3 amplitudes to first bursts of a run in the individualized HRTF condition. Condition differences in P3 amplitudes and behavior were positively correlated. Data suggests that part of the individualization benefit reflects post-sensory processes.