Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue
Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue
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DOI：
10.1177/1937586716673829
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发表时间：
2017-07-01
影响因子：
2.2
通讯作者：
Merck, Derek L.
中科院分区：
文献类型：
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作者：
Kobayashi, Leo;Gosbee, John W.;Merck, Derek L.
目标：(1) 使用人因工程 (HFE) 评估框架开发用于警报疲劳研究的临床微系统模拟方法，以及 (2) 探索其在患者监测和提供者通知的不同方法的比较检查中的应用。背景：患者监护系统的设计、实施和实际使用问题导致警报疲劳。一个多学科团队正在开发一个开源工具包，以促进床旁信息学研究并减轻警报疲劳。方法：仿真、HFE 和计算机科学专家创建了一种新颖的仿真方法来研究警报疲劳。该方法以多个相互关联的模拟患者场景为特色，具有脚本化的时间线、“分散注意力”的患者护理任务，并触发真假警报，并结合了客观指标来评估提供者和系统性能。在机构审查委员会批准的研究会议期间实施了开发的材料，该研究会议评估并比较了实验性多参数警报系统与标准监测遥测系统的受试者响应、使用特征和最终用户反馈。结果：开发了一个四患者模拟设置，其特征在于参与者任务相关性能和对警报响应的客观指标监测系统使用测试的结构化 HFE 评估（问卷和访谈）与个别护士受试者进行了两次试点和四次研究，引发了真实警报和误报反应（包括对指定任务的转移）以及对真实警报的无反应，用于测试实验系统抑制误报和警报提供者的方法。目的。
Objectives: (1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification. Background: Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue. Method: Simulation, HFE, and computer science experts created a novel simulation methodology to study alarm fatigue. Featuring multiple interconnected simulated patient scenarios with scripted timeline, "distractor'' patient care tasks, and triggered true and false alarms, the methodology incorporated objective metrics to assess provider and system performance. Developed materials were implemented during institutional review board-approved study sessions that assessed and compared an experimental multiparametric alerting system with a standard monitor telemetry system for subject response, use characteristics, and end-user feedback. Results: A four-patient simulation setup featuring objective metrics for participant task-related performance and response to alarms was developed along with accompanying structured HFE assessment (questionnaire and interview) for monitor systems use testing. Two pilot and four study sessions with individual nurse subjects elicited true alarm and false alarm responses (including diversion from assigned tasks) as well as nonresponses to true alarms. In-simulation observation and subject questionnaires were used to test the experimental system's approach to suppressing false alarms and alerting providers. Conclusions: A novel investigative methodology applied simulation and HFE techniques to replicate and study alarm fatigue in controlled settings for systems assessment and experimental research purposes.