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ABSTRACT: 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.
International Journal of Medical Informatics 01/2013; · 2.41 Impact Factor
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ABSTRACT: Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA.
Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits.
Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks.
Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements.
Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future.
Journal of the American Medical Informatics Association 03/2012; 19(4):583-90. · 3.61 Impact Factor
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ABSTRACT: Consolidated information from multiple sources (patient monitors, electronic medical records, infusion pumps, ventilators, medication references) may improve nurses' work and patient safety. Objective. Two hypotheses were tested, that integrated information displays (a) improve nurses' satisfaction and (b) lower perceived mental workload. Methods. In a counter-balanced, repeated measures design (integrated vs. traditional display) 12 ICU nurses performed realistic tasks using both display types. Results. Nurses' user interaction satisfaction was higher with the integrated display and it received more positive comments. Nurses' mean perceived mental workload scores were also lower, having significant differences in effort and frustration dimensions. A lower mental workload may reduce errors and improve treatment times. Integrated information displays have great promise, but technological factors such as bidirectional device communication must be addressed if these displays are to achieve their potential for improving patient safety.
Studies in health technology and informatics 01/2012; 180:383-7.
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ABSTRACT: Although nurses perform the majority of the clinical tasks in an intensive care unit, current patient monitors were not designed to support a nurse's workflow. Nurses constantly triage patients, deciding which patient is currently in the most need of care. To make this decision, nurses must observe the patient's vital signs and therapeutic device information from multiple sources. To obtain this information, they often have to enter the patient's room. This study addresses 3 hypotheses. Information provided by far-view monitoring displays (1) reduces the amount of time to determine which patient needs care first, (2) increases the accuracy of assigning priority to the right patient, and (3) reduces nurses mental workload. We developed 2 far-view displays to be read from a distance of 3 to 5 m without entering the patient's room. Both display vital signs, trends, alarms, infusion pump status, and therapy support indicators. To evaluate the displays, nurses were asked to use the displays to decide which of 2 patients required their attention first. They made 60 decisions: 20 with each far-view display and 20 decisions with a standard patient monitor next to an infusion pump. Sixteen nurses (median age of 27.5 years with 2.75 years of experience) participated in the study. Using the 2 far-view displays, nurses more accurately and rapidly identified stable patients and syringe pumps that were nearly empty. Median decision times were 11.3 and 12.4 seconds for the 2 far-view displays and 17.2 seconds for the control display. The 2 far-view displays reduced median decision-making times by 4.8 to 5.9 seconds, increased accuracy in assignment of priority in 2 of 7 patient conditions, and reduced nurses' frustration with the triaging task. In a clinical setting, the proposed far-view display might reduce nurses' mental workload and thereby increase patient safety.
Dimensions of critical care nursing: DCCN 30(4):206-17.
