The Impact of Head-Worn Displays on Strategic Alarm Management and Situation Awareness

Attention to Changes on a Head-Worn Display: Two Preclinical Studies with Healthcare Scenarios

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.

Analytic Review of Using Augmented Reality for Situational Awareness

Situational awareness is the perception and understanding of the surrounding environment. Maintaining situational awareness is vital for performance and error prevention in safety critical domains. Prior work has examined applying augmented reality (AR) to the context of improving situational awareness, but has mainly focused on the applicability of using AR rather than on information design. Hence, there is a need to investigate how to design the presentation of information, especially in AR headsets, to increase users' situational awareness. We conducted a Systematic Literature Review to research how information is currently presented in AR, especially in systems that are being utilized for situational awareness. Comparing current presentations of information to existing design recommendations aided in identifying future areas of design. In addition, this survey further discusses opportunities and challenges in applying AR to increasing users' situational awareness.

Acoustic Biotopes, Listeners and Sound-Induced Action: A Case Study of Operating Rooms

As socio-technological environments shape and direct listener behaviour, an ecological account is needed that encompasses listening in complexity (i.e., multiple listeners, multiple sounds and their sources, and multiple sound-induced actions that ensure the success of a mission). In this study, we explored sound-induced action under the framework of "acoustic biotopes" (a notion of ecological acoustics by Smolders, Aertsen, and Johanessma, 1979 and 1982) in a specific socio-technological environment, i.e., the context of an orthopaedic operating room. Our approach is based on literature research into the topics of environmental psychology and auditory perception and action and in situ observations in healthcare with field recordings, participatory observations, and interviews on the spot. The results suggest a human-centered definition of sound-induced action in acoustic biotopes: Acoustic biotope is an active and shared sound environment with entangled interactions and sound-induced actions taking place in a specific space that has a critical function. Listening in highly functional environments is an individual experience and is influenced by hearing function, physical position and role in an environment, and the task at hand. There is a range of active and passive sound listeners as a function of their attentive state and listeners as sound sources within the acoustic biotope. There are many different sound sources and sound locals in socio-technological environments and sounds have great potential to serve critical information to operators. Overall, our study provides a holistic, multi-layered and yet a listener-centric view on the organisation of complex spaces and the results can immediately be applicable for rethinking the acoustic environment for ORs for better listening and sound-induced action.

Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice

BACKGROUND

Accurate situation awareness has been identified as a critical component of effective deteriorating patient response systems and an essential patient safety skill for nursing practice. However, situation awareness has been defined and theorised from multiple perspectives to explain how individuals, teams and systems maintain awareness in dynamic task environments.

AIM

Our aim was to critically analyse the different approaches taken to the study of situation awareness in healthcare and explore the implications for nursing practice and research as it relates to clinical deterioration in ward contexts.

METHODS

We undertook a meta-narrative review of the healthcare literature to capture how situation awareness has been defined, theorised and studied in healthcare. Following an initial scoping review, we conducted an extensive search of ten electronic databases and included any theoretical, empirical or critical papers with a primary focus on situation awareness in an inpatient hospital setting. Included papers were collaboratively categorised in accordance with their theoretical framing, research tradition and paradigm with a narrative review presented.

RESULTS

A total of 120 papers were included in this review. Three overarching narratives reflecting philosophical, patient safety and solution focussed framings of situation awareness and seven meta-narratives were identified as follows: individual, team and systems perspectives of situation awareness (meta-narratives 1-3), situation awareness and patient safety (meta-narrative 4), communication tools, technologies and education to support situation awareness (meta-narratives 5-7). We identified a concentration of literature from anaesthesia and operating rooms and a body of research largely located within a cognitive engineering tradition and a positivist research paradigm. Endsley's situation awareness model was applied in over 80% of the papers reviewed. A minority of papers drew on alternative situation awareness theories including constructivist, collaborative and distributed perspectives.

CONCLUSIONS

Nurses have a critical role in identifying and escalating the care of deteriorating patients. There is a need to build on prior studies and reflect on the reality of nurse's work and the constraints imposed on situation awareness by the demands of busy inpatient wards. We suggest that this will require an analysis that complements but goes beyond the dominant cognitive engineering tradition to reflect the complex socio-cultural reality of ward-based teams and to explore how situation awareness emerges in increasingly complex, technologically enabled distributed healthcare systems.

The impact of cognitive load on climbing and climbing on cognitive performance

OBJECTIVE

We examined the impact of increasing cognitive load on climbing performance and the impact of climbing on concurrent cognitive task performance.

BACKGROUND

Generally when two tasks are performed simultaneously performance of one or both suffers relative to performance of each alone. Such dual task decrement is not confined to competing cognitive tasks, but has also been found when one task involves demanding physical activity.

METHOD

Skilled climbers performed a traverse climb alone and in combination with low and high cognitive load counting tasks, which were also performed alone.

RESULTS

In more realistic physical settings, physical and cognitive tasks will interfere, unlike what some literature using laboratory physical tasks may indicate.

CONCLUSION

Compared to single task (climb only) performance concurrent counting and climbing resulted in impaired performance. However, climbers appeared to prioritize climbing over cognitive task performance.

APPLICATION

The results and this program of research have implications for occupations that involve concurrent demanding physical activity and cognitive task performance. PRéCIS: High risk, physical tasks in real world conditions appear to hinder cognitive performance more so than low-risk physical tasks carried out in laboratory conditions.

Augmenting Critical Care Patient Monitoring Using Wearable Technology: Review of Usability and Human Factors

Background

Continuous monitoring of the vital signs of critical care patients is an essential component of critical care medicine. For this task, clinicians use a patient monitor (PM), which conveys patient vital sign data through a screen and an auditory alarm system. Some limitations with PMs have been identified in the literature, such as the need for visual contact with the PM screen, which could result in reduced focus on the patient in specific scenarios, and the amount of noise generated by the PM alarm system. With the advancement of material science and electronic technology, wearable devices have emerged as a potential solution for these problems. This review presents the findings of several studies that focused on the usability and human factors of wearable devices designed for use in critical care patient monitoring.

Objective

The aim of this study is to review the current state of the art in wearable devices intended for use by clinicians to monitor vital signs of critical care patients in hospital settings, with a focus on the usability and human factors of the devices.

Methods

A comprehensive literature search of relevant databases was conducted, and 20 studies were identified and critically reviewed by the authors.

Results

We identified 3 types of wearable devices: tactile, head-mounted, and smartwatch displays. In most cases, these devices were intended for use by anesthesiologists, but nurses and surgeons were also identified as potentially important users of wearable technology in critical care medicine. Although the studies investigating tactile displays revealed their potential to improve clinical monitoring, usability problems related to comfort need to be overcome before they can be considered suitable for use in clinical practice. Only a few studies investigated the usability and human factors of tactile displays by conducting user testing involving critical care professionals. The studies of head-mounted displays (HMDs) revealed that these devices could be useful in critical care medicine, particularly from an ergonomics point of view. By reducing the amount of time the user spends averting their gaze from the patient to a separate screen, HMDs enable clinicians to improve their patient focus and reduce the potential of repetitive strain injury.

Conclusions

Researchers and designers of new wearable devices for use in critical care medicine should strive to achieve not only enhanced performance but also enhanced user experience for their users, especially in terms of comfort and ease of use. These aspects of wearable displays must be extensively tested with the intended end users in a setting that properly reflects the intended context of use before their adoption can be considered in clinical settings.

Nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care: A qualitative study

PURPOSE

To describe nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care.

METHODS

Data was collected through individual semi-structured interviews with seven nurse anesthetists who had used smart glasses, with a customized application for monitoring vital signs, during clinical anesthesia care. Data was analyzed using thematic content analysis.

RESULTS

An overarching theme became evident during analysis; Facing and embracing responsibility. Being a nurse anesthetist entails a great responsibility, and the participants demonstrated that they shouldered this responsibility with pride. The theme was divided in two sub-themes. The first of these, A new way of working, comprised the categories Adoption and Utility. This involved incorporating smart glasses into existing routines in order to provide safe anesthesia care. The second sub-theme, Encountering side effects, consisted of the categories Obstacles and Personal affect. This sub-theme concerned the possibility to use smart glasses as intended, as well as the affect on nurse anesthetists as users.

CONCLUSION

Smart glasses improved access to vital signs and enabled continuous monitoring regardless of location. Continued development and improvement, both in terms of the application software and the hardware, are necessary for smart glasses to meet nurse anesthetists' needs in clinical practice.

Supporting multiple patient monitoring with head-worn displays and spearcons

In hospitals, clinicians often need to monitor several patients while performing other tasks. However, visual displays that show patients' vital signs are in fixed locations and auditory alarms intended to alert clinicians may be missed. Information such as spearcons (time-compressed speech earcons) that 'travels' with the clinician and is delivered by earpiece and/or head-worn displays (HWDs), might overcome these problems. In this study, non-clinicians monitored five simulated patients in three 10-min scenarios while performing a demanding tracking task. Monitoring accuracy was better for participants using spearcons and a HWD (88.7%) or a HWD alone (86.2%) than for participants using spearcons alone (74.1%). Participants using the spearcons and HWD (37.7%) performed the tracking task no differently from participants using spearcons alone (37.1%) but participants using the HWD alone performed worse overall (33.1%). The combination of both displays may be a suitable solution for monitoring multiple patients.

To Beep or Not to Beep? Evaluating Modalities for Multimodal ICU Alarms

Technology plays a prominent role in intensive care units (ICU), with a variety of sensors monitoring both patients and devices. A serious problem exists, however, that can reduce the sensors’ effectiveness. When important values exceed or fall below a certain threshold or sensors lose their signal, up to 350 alarms per patient a day are issued. These frequent alarms are audible in several locations on the ICU, resulting in a massive cognitive load for ICU nurses, as they must evaluate and acknowledge each alarm. “Alarm fatigue” sets in, a desensitization and delayed response time for alarms that can have severe consequences for patients and nurses. To counteract the acoustic load on ICUs, we designed and evaluated personal multimodal alarms for a wearable alarm system (WAS). The result was a lower response time and higher ratings on suitability and feasibility, as well as a lower annoyance level, compared to acoustic alarms. We find that multimodal alarms are a promising new approach to alert ICU nurses, reduce cognitive load, and avoid alarm fatigue.

An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising anesthesiologists' situation awareness

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.