It’s not you, it’s the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study
It’s not you, it’s the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study
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不是你的问题，而是设计的问题——麻醉师报告的患者监护的常见问题：一项混合定性研究
作者：
D. W. Tscholl;Lucas Handschin;J. Rössler;Mona Weiss;D. Spahn;C. Nöthiger
背景病人监护对于围手术期病人的安全至关重要，因为麻醉师通常根据病人监护仪上显示的信息做出重要的治疗决策。以前的研究表明，今天的病人监测在信息过载和警报疲劳等领域还有改进的空间。本研究的基本原理是了解更多的问题麻醉师面临的病人monitoring和获得改进建议，为下一代patient monitors.MethodsWe进行了两个中心的定性/定量研究。最初，我们采访了120名麻醉师（医生和护士），主题是：日常工作中患者监护的常见问题。通过演绎和归纳编码，我们从访谈中确定了主要主题和子主题。在第二步，实地调查，一个单独的组25名麻醉师评价他们的同意或不同意中央声明创建所有确定的主要topics.ResultsWe确定了以下六个主要议题：1。“警报”，2.“文物”，3。“软件”，4。“硬件”，5。“人的因素”，6。“系统因素”和17个子主题。被评为主要议题的中心陈述是：1。“警报设置的问题使患者监测复杂化。”(56%同意）2。“藏物使形势评估复杂化”(64%同意）3。“信息过载使得很难快速获得概述。”(56%同意）4。“电缆的问题使病人监护仪的工作复杂化。”(92%同意）5.“与人的表现有关的因素导致关键信息没有被感知。”(88%同意）6.“在不同制造商的显示器之间切换很困难。”(88%同意）。所有声明的评级显着不同的中性（所有p < 0.03）。ConclusionThis study provides a overview of problems anesthesiologists face in patient monitoring.据我们所知，其中一些问题以前未被确定为患者监护中的常见问题，例如，硬件问题（例如，电缆缠绕和磨损的连接器），人为因素方面（例如，疲劳和分心），以及系统因素方面（例如，制造商之间的标准化不足）。理想的监护仪应尽可能有效地传输相关的患者监护信息，防止误报，并使用旨在改善患者监护问题的技术。
BackgroundPatient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today’s patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors.MethodsWe conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics.ResultsWe identified the following six main topics: 1. “Alarms,” 2. “Artifacts,” 3. “Software,” 4. “Hardware,” 5. “Human Factors,” 6. “System Factors,” and 17 sub themes. The central statements rated for the major topics were: 1. “problems with alarm settings complicate patient monitoring.” (56% agreed) 2. “artifacts complicate the assessment of the situation.” (64% agreed) 3. “information overload makes it difficult to get an overview quickly.” (56% agreed) 4. “problems with cables complicate working with patient monitors.” (92% agreed) 5. “factors related to human performance lead to critical information not being perceived.” (88% agreed) 6. “Switching between monitors from different manufacturers is difficult.” (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03).ConclusionThis study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring.
DOI：
10.1056/nejmsa1201918
发表时间：
2012-05-31
期刊：
The New England journal of medicine
影响因子：
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作者：
Wallace DJ;Angus DC;Barnato AE;Kramer AA;Kahn JM
通讯作者：
Kahn JM