PURPOSE: We previously developed a strip-chart like trend-based physiological monitoring display (STA 2010 Annual Meeting, A#39) and demonstrated that nurses made faster and more accurate triaging decisions using it compared with a conventional monitor. The aim of the current work is to evaluate whether the improvement in decision making can be generalized to physicians.
METHODS: To evaluate the strip-chart like display critical care and cardiology fellows, after a brief educational session, were asked to compare the data from two unfamiliar patients and decide which patient required their attention first. Seven scenarios were used: 1) Normal-stable patients with no alarms in the past 12hr, 2) Deviation-identify from trend analysis which patient had more past alarms, 3) Alarm-identify which patient currently has one alarm, 4) Support-identify which patient requires more ventilator support (higher FiO2 and mechanical MV), 5) Syringe-identify which patient has a medication running out in < 15min, 6) Trend-identify which patient is trending towards an alarm limit, and 7) Very Sick-identify which patient currently has more alarms. Each participant made twenty decisions with the strip-chart like display, and with a combination of a Dräger patient monitor and an Alaris infusion pump (control display).
RESULTS: Seven critical care and three cardiology fellows (9 males) participated in the study. Correct assessment of priority was made more often using the strip-chart like display (72%) than when using the Control display (51%). Physicians could more accurately identify normal (equally stable patients; 70% with the strip-chart like display vs. 30% with the control display); alarm (patients with one alarm; 80% vs. 55%), and syringe (nearly empty syringe pumps; 85% vs. 20%) conditions. Decision times were equal with both displays: Median overall decision times were 14.4 sec for the strip-chart like display and 17.4 sec for the control display.
CONCLUSION: A 29% increase in triaging decision accuracy was observed with the new display.
CLINICAL IMPLICATIONS: By graphically integrating disparate information the strip-chart like display might help physicians decide which patient needs their attention first.
DISCLOSURE: Boaz Markewitz, Grant monies (from industry related sources) Matthias Görges and Dwayne Westenskow are supported in part by a research grant from Drägerwerk AG & Co. KGaA, Lübeck, Germany; Consultant fee, speaker bureau, advisory committee, etc. Dwayne Westenskow receives consulting fees from Drägerwerk AG & Co. KGaA, Lübeck, Germany; No Product/Research Disclosure Information