Clinical information displays to improve ICU outcomes
Clinical information displays to improve ICU outcomes
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DOI：
10.1016/j.ijmedinf.2008.05.004
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发表时间：
2008-11-01
影响因子：
4.9
通讯作者：
Lin, Zu-Chun
中科院分区：
文献类型：
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作者：
Effken, Judith A.;Loeb, Robert G.;Lin, Zu-Chun
目的：在以前的研究中，我们比较了以结构化图形格式表示生理数据的原型生态显示（艾德）和两个条形图显示[J.A. Effken，Improving clinical decision making through ecological interfaces，Ecol.Psych.18（2006）283-318]。在艾德和第一个条形图显示中，根据认知工作分析（CWA）对数据进行分层分组;在第二个条形图显示中，数据按通常收集的方式进行分组。处理效率（即，CWA模型中的七个变量在目标范围内的时间百分比）的改善与两个显示器合并重症监护室（ICU）住院医师的CWA命令相似，但对于ICU新手护士则不然。该结果的假设原因包括：新型显示器的实践不足;显示器之间使用相同的历史;临床知识不足;以及效率分析中使用的变量，其中仅包括艾德的四个集成设计元素之一。在目前的研究中，我们测试这些hypothes.Methods：我们要求ICU护士分配到三个知识组的基础上重症监护和血液动力学监测预测试，以确定和治疗氧合问题，通过艾德和第一个条形图显示（BGD）在实验室模拟。我们测量了显示器、临床场景、数据水平、知识、呈现顺序和实践程度对事件识别、治疗效率、认知工作量和用户满意度的影响。结果：两种显示器在识别速度或总体认知工作量方面差异不大，但ED的用户满意度更高。当仅测量7个时，BGD占优势。结果表明，在艾德中提供的这种合成是有益的，但也是潜在的限制。如果在显示器中使用太多不同的图像格式，则检测关键事件可能更困难。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: In a previous study, we compared a prototype ecological display (ED) that represented physiological data in a structured pictorial format with two bar graph displays [J.A. Effken, Improving clinical decision making through ecological interfaces, Ecol. Psych. 18 (2006) 283-318]. In ED and the first bar graph display, data were grouped hierarchically based on a cognitive work analysis (CWA); in the second bar graph display they were grouped as usually collected. Treatment efficiency (i.e., percentage of time seven variables in the CWA model were in target range) improved similarly with the two displays incorporating the CWA order for intensive care unit (ICU) residents, but not for novice ICU nurses. Hypothesized reasons for this result included: insufficient practice with novel displays; use of identical histories across displays; insufficient clinical knowledge; and the variables used in the efficiency analysis, which included only one of ED's four integrated design elements. In the current study we tested these hypotheses.Methods: We asked ICU nurses assigned to three knowledge groups based on intensive care and hemodynamic monitoring pretests to identify and treat oxygenation problems presented via ED and the first bar graph display (BGD) in an experimental laboratory simulation. We measured the impact of display, clinical scenario, data level, knowledge, presentation order, and practice extent on event recognition, treatment efficiency, cognitive workload, and user satisfaction.Results: The two displays produced little difference in recognition speed or overall cognitive workload, but user satisfaction was greater with ED. When 12 variables were included in the analysis, treatment efficiency improved with ED; when only 7 were measured, BGD prevailed. The results suggest benefits for the kind of synthesis provided in ED, but also a potential limitation. If too many different pictorial formats are used in a display, detecting critical events may be more difficult. (C) 2008 Elsevier Ireland Ltd. All rights reserved.