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1.
BMC Med Inform Decis Mak ; 20(1): 26, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041584

RESUMO

BACKGROUND: 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. 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. METHODS: A 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. RESULTS: In 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. CONCLUSIONS: In 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.

2.
J Clin Monit Comput ; 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31768924

RESUMO

Patient monitoring requires constant attention and may be particularly vulnerable to distractions, which frequently occur during perioperative work. In this study, we compared anesthesia providers' perceptive performance and perceived workload under distraction for conventional and avatar-based monitoring, a situation awareness-based technology that displays patient status as an animated patient model. In this prospective, multicenter study with a within-subject design, 38 participants evaluated scenarios of 3- and 10-s durations using conventional and avatar-based monitoring, under standardized distraction in the form of a simple calculation task. We quantified perceptual performance as the number of vital signs correctly remembered out of the total of 11 vital signs shown. We quantified perceived workload using the National Aeronautics and Space Administration Task Load Index score. Anesthesia providers remembered more vital signs under distraction using the avatar monitoring technology in the 3-s scenario: 6 (interquartile range [IQR] 5-7) vs. 3 (IQR 2-4), p < 0.001, mean of differences (MoD): 3 (95% confidence interval [95% CI] 1 to 4), and in the 10-s monitoring task: 6 (IQR 5-8) vs. 4 (IQR 2-7), p = 0.028, MoD: 1 (95% CI 0.2 to 3). Participants rated perceived workload lower under distraction with the avatar in the 3-s scenario: 65 (IQR 40-79) vs. 75 (IQR 51-88), p = 0.007, MoD: 9 (95% CI 3 to 15), and in the 10-s scenario: 68 (IQR 50-80) vs. 75 (IQR 65-86), p = 0.019, MoD: 10 (95% CI 2 to 18). Avatar-based monitoring improved anesthesia providers' perceptive performance under distraction and reduced perceived workload. This technology could help to improve caregivers' situation awareness, especially in high-workload situations.

3.
J Med Internet Res ; 21(7): e13041, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31317870

RESUMO

BACKGROUND: Continuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms. OBJECTIVE: In this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers' perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only. METHODS: We conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision. RESULTS: Overall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring. CONCLUSIONS: This study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring.

4.
BMC Anesthesiol ; 19(1): 87, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138143

RESUMO

BACKGROUND: Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today's patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors. METHODS: We conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics. RESULTS: We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub themes. The central statements rated for the major topics were: 1. "problems with alarm settings complicate patient monitoring." (56% agreed) 2. "artifacts complicate the assessment of the situation." (64% agreed) 3. "information overload makes it difficult to get an overview quickly." (56% agreed) 4. "problems with cables complicate working with patient monitors." (92% agreed) 5. "factors related to human performance lead to critical information not being perceived." (88% agreed) 6. "Switching between monitors from different manufacturers is difficult." (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03). CONCLUSION: This study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring.


Assuntos
Anestesiologistas/normas , Atitude do Pessoal de Saúde , Desenho de Equipamento/normas , Monitorização Intraoperatória/normas , Enfermeiras Anestesistas/normas , Qualidade da Assistência à Saúde/normas , Anestesiologistas/psicologia , Desenho de Equipamento/métodos , Desenho de Equipamento/psicologia , Feminino , Humanos , Masculino , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/psicologia , Inquéritos e Questionários
5.
BMC Anesthesiol ; 18(1): 188, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30537934

RESUMO

BACKGROUND: A new patient monitoring technology called Visual Patient, which transforms numerical and waveform data into a virtual model (an avatar) of the monitored patient, has been shown to improve the perception of vital signs compared to conventional patient monitoring. In order to gain a deeper understanding of the opinions of potential future users regarding the new technology, we have analyzed the answers of two large groups of anesthetists using two different study methods. METHODS: First, we carried out a qualitative analysis guided by the "consolidated criteria for reporting qualitative research" checklist. For this analysis, we interviewed 128 anesthesiologists, asking: "Where do you see advantages in Visual Patient monitoring?" and afterward identified major and minor themes in their answers. In a second study, an online survey with 38 anesthesiologists at two different institutions, we added a quantitative part in which anesthesiologists rated statements based on the themes identified in the prior analysis on an ordinal rating scale. RESULTS: We identified four high-level themes: "quick situation recognition," "intuitiveness," "unique design characteristics," and "potential future uses," and eight subthemes. The quantitative questions raised for each major theme were: 1. "The Visual Patient technology enabled me to get a quick overview of the situation." (63% of the participants agreed or very much agreed to this statement). 2. "I found the Visual Patient technology to be intuitive and easy to learn." (82% agreed or very much agreed to this statement). 3. "The visual design features of the Visual Patient technology (e.g., the avatar representation) are not helpful for patient monitoring." (11% agreed to this statement). 4. "I think the Visual Patient technology might be helpful for non-monitor experts (e.g., surgeons) in the healthcare system." (53% of the participants agreed or strongly agreed). CONCLUSION: This mixed method study provides evidence that the included anesthesiologists considered the new avatar-based technology to be intuitive and easy to learn and that the technology enabled them to get an overview of the situation quickly. Only a few users considered the avatar presentation to be unhelpful for patient monitoring and about half think it might be useful for non-experts.


Assuntos
Anestesistas/estatística & dados numéricos , Monitorização Fisiológica/métodos , Realidade Virtual , Sinais Vitais/fisiologia , Adulto , Atitude do Pessoal de Saúde , Tecnologia Biomédica/métodos , Lista de Checagem , Feminino , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Inquéritos e Questionários
6.
Br J Anaesth ; 116(5): 662-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27106970

RESUMO

BACKGROUND: Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol. METHODS: We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines. RESULTS: The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001). CONCLUSIONS: This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.


Assuntos
Anestesia/normas , Anestesiologia/educação , Recursos Audiovisuais , Educação Médica Continuada/métodos , Gravação em Vídeo , Educação Continuada em Enfermagem/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Variações Dependentes do Observador , Segurança do Paciente , Enfermagem Perioperatória/educação , Enfermagem Perioperatória/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Melhoria de Qualidade , Suíça , Materiais de Ensino
7.
JMIR Res Protoc ; 5(1): e4, 2016 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-26732090

RESUMO

BACKGROUND: Tablet computers such as the Apple iPad are progressively replacing traditional paper-and-pencil-based data collection. We combined the iPad with the ready-to-use survey software, iSurvey (from Harvestyourdata), to create a straightforward tool for data collection during the Anesthesia Pre-Induction Checklist (APIC) study, a hospital-wide multimethod intervention study involving observation of team performance and team member surveys in the operating room (OR). OBJECTIVE: We aimed to provide an analysis of the factors that led to the use of the iPad- and iSurvey-based tool for data collection, illustrate our experiences with the use of this data collection tool, and report the results of an expert survey about user experience with this tool. METHODS: We used an iPad- and iSurvey-based tool to observe anesthesia inductions conducted by 205 teams (N=557 team members) in the OR. In Phase 1, expert raters used the iPad- and iSurvey-based tool to rate team performance during anesthesia inductions, and anesthesia team members were asked to indicate their perceptions after the inductions. In Phase 2, we surveyed the expert raters about their perceptions regarding the use of the iPad- and iSurvey-based tool to observe, rate, and survey teams in the ORs. RESULTS: The results of Phase 1 showed that training data collectors on the iPad- and iSurvey-based data collection tool was effortless and there were no serious problems during data collection, upload, download, and export. Interrater agreement of the combined data collection tool was found to be very high for the team observations (median Fleiss' kappa=0.88, 95% CI 0.78-1.00). The results of the follow-up expert rater survey (Phase 2) showed that the raters did not prefer a paper-and-pencil-based data collection method they had used during other earlier studies over the iPad- and iSurvey-based tool (median response 1, IQR 1-1; 1=do not agree, 2=somewhat disagree, 3=neutral, 4=somewhat agree, 5=fully agree). They found the iPad (median 5, IQR 4.5-5) and iSurvey (median 4, IQR 4-5) to be working flawlessly and easy to use (median 5, IQR 4-5). Expert ratings also showed that the anesthesia team members (ie, the surveyed doctors and nurses) who used the iPad- and iSurvey-based tool in the OR liked it (median 4, IQR 3-4.5). CONCLUSIONS: The combination of the iPad and iSurvey provides an efficient and unobtrusive method to observe teams in their natural environment in the OR and to survey team members immediately after completing their task (ie, anesthesia induction). The expert raters positively evaluated the use of the device and user perceptions. Considering these comprehensive results, we can recommend the use of the iPad- and iSurvey-based tool for studying team performance and team member perceptions in the OR.

8.
Anesth Analg ; 121(4): 948-56, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25806399

RESUMO

BACKGROUND: An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). METHODS: A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. RESULTS: One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). CONCLUSIONS: This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.


Assuntos
Anestesia/normas , Lista de Checagem/normas , Comportamento Cooperativo , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Percepção , Anestesia/tendências , Lista de Checagem/tendências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Equipe de Assistência ao Paciente/tendências , Estudos Prospectivos , Inquéritos e Questionários
9.
Alzheimer Dis Assoc Disord ; 28(2): 156-61, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24113559

RESUMO

BACKGROUND: Dementia and mild cognitive impairment (MCI) are underrecognized in community settings. This may be due in part to the lack of brief dementia screening tools available to clinicians. We compared 2 brief, informant-based screening tests: the AD8 and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a community-based neurology practice in the midwestern United States. METHODS: We examined 186 consecutive patients (44 controls, 13 with MCI, and 129 with dementia). Receiver operator characteristic curves were used to examine the ability of AD8 and IQCODE to discriminate between controls and MCI or dementia. Sensitivity, specificity, predictive values, and likelihood ratios were reported. RESULTS: AD8 differentiated healthy controls from MCI (P<0.001) or dementia (P<0.001), and MCI from dementia (P=0.008). The IQCODE differentiated controls and MCI from dementia (both P<0.001), and between controls and MCI (P=0.002). Both AD8 (AUC=0.953; 95% confidence interval, 0.92-0.99) and IQCODE (AUC=0.930, 95% confidence interval, 0.88-0.97) provided discrimination between controls and patients with dementia; however, the AD8 had superior sensitivity detecting dementia (99.2%) and MCI (100%) compared with the IQCODE (79.1% for dementia, 46.1% for MCI) with nonoverlapping confidence intervals. Using published cut-offs (AD8≥2, IQCODE≥3.4), only 1 case of dementia was missed with the AD8, whereas the IQCODE failed to detect dementia in 27 individuals. The AD8 detected MCI in all 13 individuals, whereas the IQCODE misclassified 7 individuals. CONCLUSIONS: Both the AD8 and IQCODE were able to detect dementia in a community setting. The AD8, however, was more successful than IQCODE in detecting MCI. If simple and efficient screening for early cognitive impairment is the goal, particularly in the early stages (e.g., for prevention trials or public screening), the combination of an informant interview (the AD8) and a brief performance measure could be considered as they meet the basic requirements of the Personalized Prevention Plan for Medicare beneficiaries.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Psicometria , Curva ROC , Sensibilidade e Especificidade
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