Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: A prospective randomized controlled study

OBJECTIVE The study measured whether nurses' situation awareness would increase and task completion time decrease when they used an integrated information display compared to traditional displays for medication management, patient awareness and team communication. SETTING The Burn Trauma Intensive Care Unit (BTICU) at the University Hospital, University of Utah Health Science Center, Salt Lake City, Utah, USA. PARTICIPANTS 12 experienced BTICU nurses. MEASURES Situation awareness (accuracy of the participants' answer) and task completion time (response time from seeing the question to submitting the answer) were measured using paper prototypes of both displays. STUDY DESIGN Counter-balanced (on display order), repeated-measures design. MAIN RESULTS Nurses had a higher situation awareness when using the integrated display, with an overall accuracy of 85.3% compared to 61.8% with the traditional displays (odds ratio 3.61, P<.001, 95% CI=2.34…5.57). Task completion times were nearly half with integrated displays compared to traditional displays (median 26.0 and 42.1s, hazard ratio 2.31, P<.001, CI=1.83…2.93). CONCLUSIONS An integrated ICU information display increased nurses' situation awareness and decreased task completion time. Information integration has the potential to decrease errors, increase nurses' productivity and may allow nurses to react faster to a patient's clinical needs. Bidirectional device communication is needed for these displays to achieve full potential in improving patient safety.

[1]  Yinqi Zhang,et al.  Effects of Integrated Graphical Displays on Situation Awareness in Anaesthesiology , 2002, Cognition, Technology & Work.

[2]  Daniel J. Garland,et al.  Situation Awareness Analysis and Measurement , 2009 .

[3]  Judith A. Effken,et al.  Clinical information displays to improve ICU outcomes , 2008, Int. J. Medical Informatics.

[4]  Nancy Staggers,et al.  Using Personas and Prototypes to Define Nurses' Requirements for a Novel Patient Monitoring Display , 2009, Nursing Informatics.

[5]  Marie T. Egan,et al.  Clinical Dashboards: Impact on Workflow, Care Quality, and Patient Safety , 2006, Critical care nursing quarterly.

[6]  Nancy Staggers,et al.  Usability and Clinical Application Design , 2010 .

[7]  Pascale Carayon,et al.  Exploring performance obstacles of intensive care nurses. , 2009, Applied ergonomics.

[8]  N. Staggers,et al.  A Systematic Review of the Designs of Clinical Technology: Findings and Recommendations for Future Research , 2009, ANS. Advances in nursing science.

[9]  ALEXA K. DOIG,et al.  Graphical Arterial Blood Gas Visualization Tool Supports Rapid and Accurate Data Interpretation , 2011, Computers, informatics, nursing : CIN.

[10]  Yan Xiao,et al.  Review Paper: A Systematic Review of the Literature on Multidisciplinary Rounds to Design Information Technology , 2006, J. Am. Medical Informatics Assoc..

[11]  J. Rothschild,et al.  Adverse drug events in intensive care units: Risk factors, impact, and the role of team care , 2010, Critical care medicine.

[12]  P. Palmieri,et al.  Performance in Nursing , 2009 .

[13]  William W. Stead,et al.  Review Paper: Integration and Beyond: Linking Information from Disparate Sources and into Workflow , 2000, J. Am. Medical Informatics Assoc..

[14]  Matthias Görges,et al.  A Far-View Intensive Care Unit Monitoring Display Enables Faster Triage , 2011, Dimensions of critical care nursing : DCCN.

[15]  Gavriel Salvendy,et al.  Handbook of Human Factors and Ergonomics , 2005 .

[16]  Nancy Staggers,et al.  Evaluations of Physiological Monitoring Displays: A Systematic Review , 2008, Journal of clinical monitoring and computing.

[17]  Jennifer A. Sledge,et al.  Understanding the Cognitive Work of Nursing in the Acute Care Environment , 2005, The Journal of nursing administration.

[18]  J. Yellott.  Correction for fast guessing and the speed-accuracy tradeoff in choice reaction time , 1971 .

[19]  David Machin,et al.  Survival Analysis: A Practical Approach , 1995 .

[20]  Frank Drews,et al.  The Right Picture Is Worth a Thousand Numbers: Data Displays in Anesthesia , 2006, Hum. Factors.

[21]  Matthias Gondan,et al.  Testing the race inequality: A simple correction procedure for fast guesses , 2008 .

[22]  Mica R. Endsley,et al.  Toward a Theory of Situation Awareness in Dynamic Systems , 1995, Hum. Factors.

[23]  Charlene R. Weir,et al.  Integrated Information Displays for ICU Nurses: Field Observations, Display Design, and Display Evaluation , 2010 .

[24]  Mica R. Endsley,et al.  Measurement of Situation Awareness in Dynamic Systems , 1995, Hum. Factors.

[25]  Daniel G. Morrow,et al.  Reducing and Mitigating Human Error in Medicine , 2005 .

[26]  Anne Miller,et al.  The effects of clinical information presentation on physicians' and nurses' decision-making in ICUs. , 2009, Applied ergonomics.

[27]  Karen Holtzblatt,et al.  Rapid Contextual Design: A How-To Guide to Key Techniques for User-Centered Design , 2004, UBIQ.

[28]  Mica R. Endsley,et al.  Direct Measurement of Situation Awareness: Validity and Use of SAGAT , 2000 .