Tailoring reveals information requirements: the case of anaesthesia alarms

Abstract

We discuss the phenomenon of system tailoring in the context of data from an observational study of anaesthesia. We found that anaesthetists tailor their monitoring equipment so that the auditory alarms are more informative. However, the occurrence of tailoring by anaesthetists in the operating theatre was infrequent, even though the flexibility to tailor exists on many of the patient monitoring systems used in the study. We present an influence diagram to explain how alarm tailoring can increase situation awareness in the operating theatre but why factors inhibiting tailoring prevent widespread use. Extending the influence diagram, we discuss ways that more informative displays could achieve the results sought by anaesthetists when they tailor their alarm systems. In particular, we argue that we should improve our designs rather than simply provide more flexible tailoring systems, because users often find tailoring a complex task. We conclude that properly designed auditory displays may benefit anaesthetists in achieving greater patient situation awareness and that designers should consider carefully how factors promoting and inhibiting tailoring will affect the end-users' likelihood of conducting tailoring. q

Sonification Supports Eyes-Free Respiratory Monitoring and Task Time-Sharing

“…Several studies have demonstrated that most auditory alarms are ignored, are considered to be a nuisance, or serve simply as a reminder of a previously known state of affairs (Seagull & Sanderson, 2001;Watson et al, 2004;Xiao, Mackenzie, Seagull, & Jaberi, 2000). Interface design in human factors has focused on visual displays, with only sparse research on other sensory modalities Sarter, 2000 Three experiments explored the effectiveness of continuous auditory displays, or sonifications, for conveying information about a simulated anesthetized patient's respiration.…”

“…Although blood pressure is important for clinical monitoring, readings from an invasive arterial line would be required for a BP sonification. Most operations use noninvasive blood pressure, which is sampled only every few minutes and cannot be validly sonified (for further details see Watson et al, 2004).…”

“…Some work environments stand out because of the apparent difficulty of achieving this goal. For example, many researchers have pointed out that the anesthesiologist is poorly supported by the design of the anesthesia machine and the associated patient monitoring systems (Cook & Woods, 1996;Seagull & Sanderson, 2001;Watson, Sanderson, & Russell, 2004). The commonly noted frustration with auditory alarm systems is a symptom of the wrong information (critical boundaries rather than trends) arriving at the wrong time (when many other things may also be going wrong) and in the wrong format (an auditory format that must be silenced for work to proceed effectively).…”

Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff

“…In the homecare environment this could involve customising the device to make it look discreet (O'Kane et al, 2015). In the hospital context equipment could be modified beyond the original design intent, as per accounts relating to barcoding systems (Koppel et al, 2008), alarm settings (Watson et al, 2004), physiological monitors (Cook and Woods, 1996) infusion pumps (Obradovich and Woods, 1996) and glucometers (Furniss et al, 2015).…”

Monitoring practice and alarm technology in anaesthesiology

“…Less consideration is devoted to the detailed analysis of how practitioners themselves organize and configure their activities to avoid critical problems and alarms. There is an emerging body of studies concerned with tailoring practices and improvisational work [6,7]. However, there is a tendency in this body of literature to favour the consideration of how improvisations and workarounds can be avoided by better technical design rather than examining how those tailoring and configuring practices should be supported as an integral and necessary part of the actual work.…”