Visual Cueing with Context Relevant Information for Reducing Change Blindness

ObjectivePhysiological monitoring is a requisite for optimal care to ensure that the condition of a patient is maintained within safe levels. Monitoring can be jeopardized by the inability of a clinician to recognize important changes in the visual display of data throughout the duration of the monitoring task. We hypothesized that the addition of a visual cue imparting contextual information to a physiological display would improve the detection ability and response time of a clinician to a change in a patient variable.MethodsContextual information based on trend information was added to a physiological display in the form of a visual cue. Following IRB approval, the resulting enhanced display was evaluated by 22 anesthesiologists in a simulated operating room, through the observation of six simulated scenarios using a standard anesthesia display and the enhanced display. Demographic information, response time, accuracy of detection, and usability data were collected.ResultsThe enhanced display reduced the detection time to a change in the simulated scenarios by 14.4 s (95% CI: −26.4 to −2.38), and reduced the expected number of missed events per scenario by 0.23 (95% CI: −0.439 to −0.0203), based on the repeated measures analysis (Poisson model).ConclusionsThe data collected and analyzed in this study supports the addition of a visual cue to future physiological monitors. The graphic representation and the context relevant information that it transmits appears to aid clinicians. While the results indicate that enhanced visualization of context relevant information can lead to a significant improvement in event recognition and identification, further evaluation in clinical settings is required.

[1]  James R. Lewis,et al.  IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use , 1995, Int. J. Hum. Comput. Interact..

[2]  Ronald A. Rensink,et al.  TO SEE OR NOT TO SEE: The Need for Attention to Perceive Changes in Scenes , 1997 .

[3]  G. Rau,et al.  Evaluation of Two New Ecological Interface Approaches for the Anesthesia Workplace , 2004, Journal of Clinical Monitoring and Computing.

[4]  Matthew B. Weinger,et al.  A331 Naloxonazine blocks alfentanil-induced analgesia but not muscle rigidity in the rat , 1990 .

[5]  Clay Spinuzzi,et al.  The Methodology of Participatory Design , 2005 .

[6]  Matthew B. Weinger,et al.  Ergonomic and Human Factors Affecting Anesthetic Vigilance and Monitoring Performance in the Operating Room Environment , 1990, Anesthesiology.

[7]  N. Ayas,et al.  The public health and safety consequences of sleep disorders. , 2007, Canadian journal of physiology and pharmacology.

[8]  Joel S. Warm,et al.  Effects of Cueing and Knowledge of Results on Workload and Boredom in Sustained Attention , 1999, Hum. Factors.

[9]  William N. Dember,et al.  VIGILANCE AND WORKLOAD IN AUTOMATED SYSTEMS. , 1996 .

[10]  J. McIntyre,et al.  Ergonomics: Anaesthetists’ use of auditory alarms in the operating room , 1985, International journal of clinical monitoring and computing.

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

[12]  Ronald A. Rensink,et al.  Change blindness: past, present, and future , 2005, Trends in Cognitive Sciences.

[13]  U. Fayyad,et al.  Information Visualization in Data Mining and Knowledge Discovery , 2001 .

[14]  G. Finley,et al.  Perceived urgency and the anaesthetist: responses to common operating room monitor alarms , 1991, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  Guy A Dumont,et al.  An Evaluation of a Novel Software Tool for Detecting Changes in Physiological Monitoring , 2009, Anesthesia and analgesia.

[16]  J. Ware,et al.  Random-effects models for longitudinal data. , 1982, Biometrics.

[17]  Matthew B. Weinger Vigilance, Boredom, and Sleepiness , 2004, Journal of Clinical Monitoring and Computing.

[18]  Mustapha Mouloua,et al.  Automation and Human Performance : Theory and Applications , 1996 .

[19]  J Mark Ansermino,et al.  A Novel Vibrotactile Display to Improve the Performance of Anesthesiologists in a Simulated Critical Incident , 2008, Anesthesia and analgesia.

[20]  David J. Stone,et al.  Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: An alternative paradigm for intensivist staffing* , 2004, Critical care medicine.

[21]  Ping Yang,et al.  Adaptive Change Detection in Heart Rate Trend Monitoring in Anesthetized Children , 2006, IEEE Transactions on Biomedical Engineering.

[22]  Marcus Watson,et al.  Designing for Attention With Sound: Challenges and Extensions to Ecological Interface Design , 2007, Hum. Factors.

[23]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[24]  G. Matthews Human Performance: Cognition, Stress and Individual Differences , 2000 .

[25]  Michael S. Ambinder,et al.  Change blindness , 1997, Trends in Cognitive Sciences.

[26]  R S Newbower,et al.  An Analysis of Major Errors and Equipment Failures in Anesthesia Management: Considerations for Prevention and Detection , 1984, Anesthesiology.

[27]  Catherine M. Burns,et al.  Ecological Interface Design , 2004 .

[28]  J. Tinker,et al.  Role of monitoring devices in prevention of anesthetic mishaps: a closed claims analysis. , 1989, Anesthesiology.