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Sanderson PM, Loeb RG, Liley H, Liu D, Paterson E, Hinckfuss K, Zestic J. Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones. Biomed Instrum Technol 2022; 56:46-57. [PMID: 35671368 PMCID: PMC9767428 DOI: 10.2345/0899-8205-56.2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Penelope M Sanderson
- Penelope M. Sanderson, PhD, is professor of cognitive engineering and human factors in the Schools of Psychology, Clinical Medicine, and Information Technology and Electrical Engineering at The University of Queensland in Queensland, Australia.
| | - Robert G Loeb
- Robert G. Loeb, MD, is an honorary professor in the School of Psychology at The University of Queensland in Queensland, Australia, and an emeritus clinical professor at University of Florida-Gainesville
| | - Helen Liley
- Helen Liley, MBCh, FRACP, is a senior staff specialist at Mater Mothers' Hospital and a professor in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - David Liu
- David Liu, MBBS, PhD, is an anaesthetics registrar at Sunshine Coast University Hospital in Queensland, Australia, and a senior lecturer in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - Estrella Paterson
- Estrella Paterson, PhD, is a postdoctoral fellow in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Kelly Hinckfuss
- Kelly Hinckfuss, MPhil, is a clinical masters student in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Jelena Zestic
- Jelena Zestic, PhD, is a human systems engineer at Boeing Research and Technology in Brisbane, Australia
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Sanderson PM, Loeb RG, Liley H, Liu D, Paterson E, Hinckfuss K, Zestic J. Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones. Biomed Instrum Technol 2022. [PMID: 35671368 DOI: 10.2345/1943-5967-56.2.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Penelope M Sanderson
- Penelope M. Sanderson, PhD, is professor of cognitive engineering and human factors in the Schools of Psychology, Clinical Medicine, and Information Technology and Electrical Engineering at The University of Queensland in Queensland, Australia.
| | - Robert G Loeb
- Robert G. Loeb, MD, is an honorary professor in the School of Psychology at The University of Queensland in Queensland, Australia, and an emeritus clinical professor at University of Florida-Gainesville
| | - Helen Liley
- Helen Liley, MBCh, FRACP, is a senior staff specialist at Mater Mothers' Hospital and a professor in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - David Liu
- David Liu, MBBS, PhD, is an anaesthetics registrar at Sunshine Coast University Hospital in Queensland, Australia, and a senior lecturer in the Faculty of Medicine at The University of Queensland in Queensland, Australia
| | - Estrella Paterson
- Estrella Paterson, PhD, is a postdoctoral fellow in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Kelly Hinckfuss
- Kelly Hinckfuss, MPhil, is a clinical masters student in the School of Psychology at The University of Queensland in Queensland, Australia
| | - Jelena Zestic
- Jelena Zestic, PhD, is a human systems engineer at Boeing Research and Technology in Brisbane, Australia
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The Influence of Audible Alarm Loudness and Type on Clinical Multitasking. J Med Syst 2021; 46:5. [PMID: 34812925 DOI: 10.1007/s10916-021-01794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
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.
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Collett R, Salisbury I, Loeb RG, Sanderson PM. Smooth or Stepped? Laboratory Comparison of Enhanced Sonifications for Monitoring Patient Oxygen Saturation. HUMAN FACTORS 2020; 62:124-137. [PMID: 31180734 DOI: 10.1177/0018720819845742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Are Anesthesiology Providers Good Guessers? Heart Rate and Oxygen Saturation Estimation in a Simulation Setting. Anesthesiol Res Pract 2019; 2019:5914305. [PMID: 31428146 PMCID: PMC6679872 DOI: 10.1155/2019/5914305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Anesthesia providers may need to interpret the output of vital sign monitors based on auditory cues, in the context of multitasking in the operating room. This study aims to evaluate the ability of different anesthesia providers to estimate heart rate and oxygen saturation in a simulation setting. Methods Sixty anesthesia providers (residents, nurse anesthetics, and anesthesiologists) were studied. Four scenarios were arranged in a simulation context. Two baseline scenarios with and without waveform visual aid, and two scenarios with variation of heart rate and/or oxygen saturation were used to assess the accuracy of the estimation made by the participants. Results When the accurate threshold for the heart rate was set at less than 5 beats per minute, the providers only had a correct estimation at two baseline settings with visual aids (p=0.22 and 0.2237). Anesthesia providers tend to underestimate the heart rate when it increases. Providers failed to accurately estimate oxygen saturation with or without visual aid (p=0.0276 and 0.0105, respectively). Change in recording settings significantly affected the accuracy of heart rate estimation (p < 0.0001), and different experience levels affected the estimation accuracy (p=0.041). Conclusion The ability of anesthesia providers with different levels of experience to assess baseline and variations of heart rate and oxygen saturation is unsatisfactory, especially when oxygen desaturation and bradycardia coexist, and when the subject has less years of experience.
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Zestic J, Brecknell B, Liley H, Sanderson P. A Novel Auditory Display for Neonatal Resuscitation: Laboratory Studies Simulating Pulse Oximetry in the First 10 Minutes After Birth. HUMAN FACTORS 2019; 61:119-138. [PMID: 30260681 DOI: 10.1177/0018720818793769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
| | | | - Helen Liley
- The University of Queensland, St Lucia, Australia
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Bidelman GM. Sonification of scalp-recorded frequency-following responses (FFRs) offers improved response detection over conventional statistical metrics. J Neurosci Methods 2018; 293:59-66. [DOI: 10.1016/j.jneumeth.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
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Deschamps ML, Sanderson P, Hinckfuss K, Browning C, Loeb RG, Liley H, Liu D. Improving the detectability of oxygen saturation level targets for preterm neonates: A laboratory test of tremolo and beacon sonifications. APPLIED ERGONOMICS 2016; 56:160-169. [PMID: 27184324 DOI: 10.1016/j.apergo.2016.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
Recent guidelines recommend oxygen saturation (SpO2) levels of 90%-95% for preterm neonates on supplemental oxygen but it is difficult to discern such levels with current pulse oximetry sonifications. We tested (1) whether adding levels of tremolo to a conventional log-linear pulse oximetry sonification would improve identification of SpO2 ranges, and (2) whether adding a beacon reference tone to conventional pulse oximetry confuses listeners about the direction of change. Participants using the Tremolo (94%) or Beacon (81%) sonifications identified SpO2 range significantly more accurately than participants using the LogLinear sonification (52%). The Beacon sonification did not confuse participants about direction of change. The Tremolo sonification may have advantages over the Beacon sonification for monitoring SpO2 of preterm neonates, but both must be further tested with clinicians in clinically representative scenarios, and with different levels of ambient noise and distractions.
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Affiliation(s)
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Australia; School of ITEE, The University of Queensland, Australia; School of Medicine, The University of Queensland, Australia.
| | - Kelly Hinckfuss
- School of Psychology, The University of Queensland, Australia
| | | | - Robert G Loeb
- Department of Anesthesiology, University of Arizona, USA
| | - Helen Liley
- School of Medicine, The University of Queensland, Australia; Mater Mothers Hospital, Australia
| | - David Liu
- School of ITEE, The University of Queensland, Australia; School of Medicine, The University of Queensland, Australia
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Affiliation(s)
- Joseph Schlesinger
- From the Departments of Anesthesiology, Biomedical Engineering, and Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Paterson E, Sanderson PM, Paterson NAB, Liu D, Loeb RG. The effectiveness of pulse oximetry sonification enhanced with tremolo and brightness for distinguishing clinically important oxygen saturation ranges: a laboratory study. Anaesthesia 2016; 71:565-72. [DOI: 10.1111/anae.13424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Affiliation(s)
- E. Paterson
- School of Psychology The University of Queensland Brisbane Queensland Australia
| | - P. M. Sanderson
- Schools of ITEE, Psychology, and Medicine The University of Queensland Brisbane Queensland Australia
| | | | - D. Liu
- School of ITEE The University of Queensland Brisbane Queensland Australia
| | - R. G. Loeb
- Department of Anesthesiology College of Medicine University of Arizona Arizona Tucson USA
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Hinckfuss K, Sanderson P, Loeb RG, Liley HG, Liu D. Novel Pulse Oximetry Sonifications for Neonatal Oxygen Saturation Monitoring: A Laboratory Study. HUMAN FACTORS 2016; 58:344-359. [PMID: 26715687 DOI: 10.1177/0018720815617406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We aimed to test whether the use of novel pulse oximetry sounds (sonifications) better informs listeners when a neonate's oxygen saturation (SpO2) deviates from the recommended range. BACKGROUND Variable-pitch pulse oximeters do not accurately inform clinicians via sound alone when SpO2 is outside the target range of 90% to 95% for neonates on supplemental oxygen. Risk of blindness, organ damage, and death increase if SpO2 remains outside the target range. A more informative sonification may improve clinicians' ability to maintain the target range. METHOD In two desktop experiments, nonclinicians' ability to detect SpO2 range and direction of change was tested with novel versus conventional sonifications of simulated patient data. In Experiment 1, a "shoulder" sonification used larger pitch differences between adjacent saturation percentages for SpO2 values outside the target range. In Experiment 2, a "beacon" sonification used equal-appearing pitch differences, but when SpO2 was outside the target range, a fixed-pitch reference tone from the center of the target SpO2 range preceded every fourth pulse tone. RESULTS The beacon sonification improved range identification accuracy over the control display (85% vs. 60%; p < .001), but the shoulder sonification did not (55% vs. 52%). CONCLUSION The beacon provided a distinct auditory alert and reference that significantly improved nonclinical participants' ability to identify SpO2 range. APPLICATION Adding a beacon to the variable-pitch pulse oximeter sound may help clinicians identify when, and by how much, a neonate's SpO2 deviates from the target range, particularly during patient transport situations when auditory information becomes essential.
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Affiliation(s)
- Kelly Hinckfuss
- The University of Queensland, St. Lucia, AustraliaUniversity of Arizona, TucsonMater Mothers' Hospital, Brisbane, AustraliaThe University of Queensland, St. Lucia, Australia
| | | | | | | | - David Liu
- The University of Queensland, St. Lucia, Australia
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