In academic medicine, anesthetic care is mostly provided by trainee anesthesiologists but
always supervised by more experienced clinicians.
These Supervisors are especially skilled at recognizing critical situations early on and
taking appropriate action.
But what happens if in an operating room the patient's condition suddenly deteriorates
and there is no supervisor on site to help?
This may happen, because for example at the University Hospital of Wuerzburg there are
two responsible supervisors per shift
but operations are performed in up to 6 rooms at the same time.
in addition, there are 10 other rooms in which patients are induced into anesthesia or are
in the process of waking up.
Regardless of where they are, each supervisor only knows the current vital signs of a single patient.
There is one central monitoring station in the supervisor s office that display's vital
signs of patients in all operating rooms.
But supervisors don't have the time to spend all day in their office.
typically, they move between rooms to train staff, conduct special procedures or relieve
someone for a break, and therefore cannot keep a permanent watch on the central monitoring station.
So, in many cases, the supervisors rely on junior anesthesiologists to identify problems
in a timely manner, contact their supervisors by phone, and communicate all relevant information.
Supervisors would benefit from improved Situation Awareness within the operating suite.
Meaning the perception and comprehension of information and anticipation of potential
future situations across all rooms.
But how should they get access to the necessary information?
Handheld devices are inconvenient to operate especially when performing manual tasks.
Smart watches are always accessible but would violate the bare below elbows policy which
prohibits the use of wrist accessories
Instead - A head worn display would solve both of these problems.
However, for the use case with multiple patients, only a few relevant research papers have been published so far.
For one - Pascale and colleagues developed an application in 2018 that displays
vital signs and alarms for up to 6 rooms.
In a user study, they were able to show that the head worn display helps to prioritize
the treatment sequence of patients and improves reaction times regarding clinical alarms.
but only in a virtual hospital environment on the computer
and only with nurses in training as trial participants.
Schlosser and colleagues, on the other hand, mirrored real vital sign data from 6 operating
rooms onto a head worn display and tested it with supervisors during their regular work.
Participants noticed significantly more alarms from surrounding rooms demonstrating that
monitoring multiple patients with a mobile head worn display is possible and could
be a good addition to central monitoring stations.
However, it was noted that the buttons on the headset made it difficult to interact
with the glasses and that the selection of displayed data was often insufficient for decision making.
This challenge motivated us in our work.
Our plan was to develop a new prototype that is easier to use, displays meaningful contextual
information, and can be tested with simulated patient data in a realistic clinical setting.
Following a user-centered design approach, we conducted 12 interviews with mostly supervising
anesthesiologists at the University Hospital of Wuerzburg, iteratively elaborating our design concept.
Based on this, we then developed a new app prototype for the android based Vuzix M300 smart glasses.
Let me show you what it looks like.
On this computer I have defined which vital signs should be sent to the glasses and will
now start the wireless data transmission.
On the head worn display, I can then see the vital sign data of all patients.
Not only for the operating rooms, as in the previous designs, but also
for the induction and emergence units.
As soon as a parameter falls below a certain threshold, an alarm is triggered in the room
and also displayed on the head worn display.
I can now use voice interaction to access detail information for a specific operating room
so if I say for example "Operation 2"
I can now see that the patient is 78 years old and weighs 86 kilograms.
I also see the development of the vital signs over the past 30 minutes and which mediations
were administered to the patient
Finally, I can return to the overview screen also via voice command or - as an alternative
by using this Bluetooth connected push button.
We then asked ourselves - how is the prototype actually being used by supervisors?
How does it influence situation awareness?
And how do supervisors experience the interaction in a clinical environment.
We have tested our prototype in an explorative user study with 6 supervisor anesthesiologists
in a simulation room at the University Hospital of Wuerzburg.
each participant took care of an artificial patient and simultaneously supervised 5 fictitious
surgeries in other rooms using the head worn display.
For this purpose, we developed a twenty-minute scenario covering the condition of all six patients.
with both minor and major adverse events and incoming phone calls from junior anesthesiologists
in other operating rooms
after the simulation we interviewed each participant about the events and the general user experience.
we independently reviewed all footage with two researchers to conduct a thematic analysis
and these are just some of our findings.
Overall, the participants found that the Head-Worn-Display was well designed and valuable for their work.
This is especially noteworthy since in previous surveys many clinicians showed reluctance
towards using ubiquitous remote monitoring devices
The participants made numerous proactive calls to junior anesthesiologists and before calling
frequently opened the associated detailed screen for the room in question.
During a call the participants were able to provide specific treatment advice, sometimes
without asking any questions.
Similarly, participants returned to the overview after ending a phone call, indicating an interest
in obtaining an updated state of awareness regarding other patients' vital signs
participants noticed all adverse events in other operating rooms and proactively reacted
to the most critical ones.
they stated that there were no surprises during the simulation and that they were able to
think ahead of any incoming calls thanks to the head worn display
thus, we can assume that the HWD did support
situation awareness, not only for the detection but also comprehension and projection of events
In some rare cases we also observed that perceiving and understanding the information on the HWD
required a certain level of attention as you can see in the freezing of body posture in
this clip
In fact - Most participants made comments that indicated a general increase in mental
workload as the head worn display encouraged them to constantly observe and interpret the
situation in other rooms.
The frequency of alarms was perceived as the major contributing factor to mental workload
and might require some form of intelligent filtering as one participant stated:
I didn't feel overloaded but I don t know if I could handle the alarms from all six rooms
To further assess and quantify effects on situation awareness mental workload and clinical
performance an experimental study with control group must be conducted.
another participant stated
If there had been a nurse present, I would have told her to take care of my patient so
that i can pay more attention to the critical rooms
this shows how in a non-simulated environment the coordination of staff helps supervisors
to control their own workload which was not possible during our scenario.
Further design work should also place a stronger focus on the junior anesthesiologists perspective.
A study on mobile devices in the context of collaboration during emergencies found that
remote team members have an interest in sharing information with other team members to establish
Situation Awareness
Similarly, junior anesthesiologists could highlight certain rooms on the supervisors
head worn display or send push notifications for specific events.
All in all, we have demonstrated that our design for a head worn display application
can support situation awareness and decision- making processes of supervisors by presenting
relevant information and incorporating adequate means of human-technology interaction.
Future efforts should focus on reducing mental workload.
Moreover, it is important to consider how novel ubiquitous monitoring technology will
change clinical and educational supervision in future academic medicine.
Long-term clinical trials will be required to produce these insights.