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Nurses and clinicians require knowledge and training of their facilities' code blue response cart to manage emergency scenarios. However, the nurses who access the carts change frequently through turnover and role changes. An augmented reality training solution was built for mobile devices, but encountered distribution and access challenges. This study evaluated the conversion of the mobile application to a desktop-based version deployed via a learning management system. Eight hundred fifty clinicians were assigned the interactive learning product, which collected anonymous usage data and an optional feedback survey within the module. Of 850 assigned users, 468 completed the module, and 338 completed the feedback survey. Respondents indicated a positive difference of 25.3% in retrospective pre/post confidence and an appreciation for the features of the product. Performance measured by decreasing total item search time appeared to level off after three plays. The format transition was successful, allowing the same widespread distribution as the mobile versions of [X]. Feedback gathered will drive improvements in the module., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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.

Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training., Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery., Patient Involvement: The app under study is designed to improve doctor-patient communication., Methods: The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill., Results: Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)]., Discussion: Despite positive reviews of app use, overall use was low and there was no association with achieving mastery., Practical Value: Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated., Availability of Data and Materials: The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request., (Copyright © 2021 Elsevier B.V. All rights reserved.)

An augmented reality (AR) mobile smartphone application was developed for clinicians to improve their knowledge about the contents and organisation of a standardised paediatric code cart, an important tool in safe, effective paediatric resuscitations. This study used focus groups and interviews with 22 clinicians to identify work system barriers and facilitators to use of the application. We identified twelve dimensions of barriers and facilitators: convenience, device ownership, device size and type, gamification, interface design, movement/physical space, perception of others, spatial presence, technological experience, technological glitches, workload, and the perception and attitude towards code cart and resuscitation. These dimensions can guide improvement efforts, e.g. redesigning the interface, providing non-AR modes, improving the tutorial. We propose nine principles to guide the design of other digital health technologies incorporating AR. In particular, the workload demands created by using AR must be considered and accounted for in the design and implementation of such technologies. Practitioner summary : Augmented reality (AR) may prepare workers for situations that do not occur frequently. This study investigates barriers and facilitators to using an AR mobile smartphone application developed to improve clinician knowledge about code carts, leading to improvements to the application and principles to guide the design of other AR-based technologies.