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TECHNOLOGY, COMPUTING, AND SIMULATION

Evaluation of Graphic Cardiovascular Display in a High-Fidelity Simulator

James Agutter, M.Arch^*, Frank Drews, PhD, Noah Syroid, MS, Dwayne Westneskow, PhD, Rob Albert, MS, David Strayer, PhD, Julio Bermudez, PhD^*, and Matthew B. Weinger, MD

*Graduate School of Architecture, Department of Anesthesiology, and Department of Psychology, University of Utah, Salt Lake City, Utah; and Department of Anesthesiology, University of California, San Diego, and San Diego Center for Patient Safety, Veterans Affairs San Diego Medical Center, San Diego, California

Address correspondence to James Agutter, M.Arch, Graduate School of Architecture, University of Utah, 375 S. 1530 E. Rm. 235, Salt Lake City, UT 84112. Address e-mail to agutterja{at}arch.utah.edu

"Human error" in anesthesia can be attributed to misleading information from patient monitors or to the physician’s failure to recognize a pattern. A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. We designed a graphic display to show hemodynamic variables. Twenty anesthesiologists were asked to assume care of a simulated patient. Half the participants used the graphic cardiovascular display; the other half used a Datex As/3 monitor. One scenario was a total hip replacement with a transfusion reaction to mismatched blood. The second scenario was a radical prostatectomy with 1.5 L of blood loss and myocardial ischemia. Subjects who used the graphic display detected myocardial ischemia 2 min sooner than those who did not use the display. Treatment was initiated sooner (2.5 versus 4.9 min). There were no significant differences between groups in the hip replacement scenario. Systolic blood pressure deviated less from baseline, central venous pressure was closer to its baseline, and arterial oxygen saturation was higher at the end of the case when the graphic display was used. The study lends some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians’ ability to detect, diagnose, manage, and treat critical cardiovascular events in a simulated environment.

IMPLICATIONS: A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. A user-centered design process led to a novel object-oriented graphic display of hemodynamic variables containing emergent features and functional relationships. In a simulated environment, this display appeared to support clinicians’ ability to diagnose, manage, and treat a critical cardiovascular event in a simulated environment. We designed a graphic display to show hemodynamic variables. The study provides some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians’ ability to detect, diagnosis, mange, and treat critical cardiovascular events in a simulated environment.

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