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Pediatric codes are rare events that require fast intervention from medical professionals to resuscitate a child. A pediatric code cart contains all medications and equipment immediately needed to complete a pediatric resuscitation, but not all health care professionals (HCPs) know what is located on the cart and where. A mobile, augmented reality (AR) application was created to improve this knowledge. Ten participants performed a timed search on the cart while wearing Tobii Pro eye tracking glasses before and after exposure to the application. Also, a survey to assess participants’ confidence using the code cart was administered before and after exposure to the application; the post survey also contained usability and satisfaction scales. The results showed that performance and confidence improved after using the application, and that the application usability is acceptable. Our findings suggest the application is useful for improving knowledge and efficiency while working with a pediatric code cart.

Objective We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve a mobile phone-based augmented reality application that teaches users about the contents of a standardized pediatric code cart. Background Understanding interactions between performance obstacles and facilitators can provide guidance to (re)designing sociotechnical systems to improve system outcomes. Clinicians should know about contents and organization of code carts, and an augmented reality mobile application may improve that knowledge but changes the sociotechnical system in which they learn. Prior work identified barriers and facilitators impacting the use of this application—participants described dimensions together, indicating interactions that are explored in the current study. Method We conducted four focus groups (number of clinicians = 18) and two interviews with clinicians who used the application. We performed a secondary analysis of focus group data exploring interactions between previously identified barriers and facilitators to application use. We used epistemic network analysis to visualize these interactions. Results Work system barriers interacted with barriers and facilitators interacted with facilitators to amplify cumulative negative or positive impact, respectively. Facilitators balanced barriers, mitigating negative impact. Facilitators also exacerbated barriers, worsening negative impact. Conclusion Barriers and facilitators interact and can amplify, balance, and exacerbate each other—notably, positives are not always positive. To obtain desired outcomes, interactions must be further considered in sociotechnical system design, for example, the potential improvements to the application we identified.